Safety of Pregnancy After Primary Breast Carcinoma in Young Women: A Meta-Analysis to Overcome Bias of Healthy Mother Effect Studies
Onkologkliniken Sörmland, Mälarsjukhuset, Central Hospital of Eskilstuna, Eskilstuna, Sweden. Obstetrical & gynecological survey
(Impact Factor: 1.86).
12/2010; 65(12):786-93. DOI: 10.1097/OGX.0b013e31821285bf
An increased number of women are expected to conceive after the diagnosis of early breast cancer. Most physicians recommend that pregnancy be delayed by 2 to 3 years after diagnosis of early breast cancer, but this recommendation is based on data from trials with small patient cohorts. Furthermore, a healthy mother effect (HME) selection bias may be operative in most of these studies, because women undergoing childbearing after treatment were healthier when compared with the control group.
To perform a systematic review and meta-analysis of published trials corrected for HME bias so as to assess the effect of pregnancy (at least 10 months after diagnosis) versus no pregnancy on overall survival of primary breast cancer patients less than 45 years.
We searched MEDLINE and Thomson Reuters (ISI) Web of Knowledge for eligible studies. From each study we extracted the relative hazard ratio or, if not provided, all the necessary data to impute it. In cases where the duration from diagnosis to pregnancy was not reported, we extracted relevant data to estimate it.
Our electronic search strategy yielded 1623 hits pertaining to 20 potentially eligible studies involving 49,370 premenopausal breast cancer patients. Ten studies were eligible after considering HME potential bias in matching controls. Among these, 9 studies (pregnant 1089, matched-controls 13051) contained data appropriate for analysis. Overall survival was statistically higher among patients who became pregnant compared to controls: fixed effect model estimated pooled hazard ratio for death 0.51 (95% confidence interval: 0.42-0.62). No study heterogeneity was observed: Q = 10.4, P = 0.17; I(2) = 48%.
The pooled available evidence indicates that in early breast cancer patients, pregnancy that occurs at least 10 months after diagnosis does not jeopardize prognosis and may actually confer significant survival benefit.
Obstetricians & Gynecologists, Family Physicians.
After completing this CME activity, physicians should be better able to assess the effect pregnancy has on long-term survival in primary breast cancer patients under age 45; counsel patients on the safety of pregnancy after breast cancer diagnosis and treatment; and interpret how pregnancy may be associated with improved breast cancer survival.
Available from: PubMed Central
- "In a subgroup analysis, they compared the outcome of women with a history of breast cancer that became pregnant to breast cancer patients who did not get pregnant and did not find a difference in survival between the groups. A separate meta-analysis also controlling for the “healthy mother effect” also found similar results with a survival that was higher among early stage breast cancer patients compared to control (hazard ratio 0.51) for pregnancy that occurred at least 10 months after the diagnosis . "
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ABSTRACT: Given the increases in 5-year cancer survival and recent advances in fertility preserving technologies, an increasing number of women with cancer are presenting for discussion of fertility preserving options. This review will summarize the risk of infertility secondary to cancer treatment, available treatment options for fertility preservation, and techniques to reduce future risks for patients. Concerns that will be addressed include the risk of the medications and procedures, the potential delay in cancer treatment, likelihood of pregnancy complications, as well as the impact of future pregnancy on the recurrence risk of cancer. Recent advances in oocyte cryopreservation and ovarian stimulation protocols will be discussed. Healthcare providers need to be informed of available treatment options including the risks, advantages, and disadvantages of fertility preserving options to properly counsel patients.
Obstetrics and Gynecology International 03/2012; 2012(1):953937. DOI:10.1155/2012/953937
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ABSTRACT: Future fertility is a concern for many young breast cancer survivors. Secondary amenorrhea occurs frequently during or soon after oncologic treatment. Return of menstruation and serum biomarkers are not absolute predictors of future fertility. We report a case of a 28 year old gravida 0 with recurrent Stage IIB invasive ductal breast carcinoma who managed to conceive twice despite showing clinical and biochemical signs of decreased ovarian reserve following treatment with chemotherapy and radiation. This case illustrates the potential for fertility in a patient with breast cancer despite chemotherapy-related amenorrhea and undetectable anti-Müllerian hormone levels. It exemplifies the imprecise nature of all clinical tests used to predict future fertility in breast cancer patients post-treatment. It should remind all providers to be careful in basing recommendations for childbearing on these surrogate endpoints.
Reproductive Medicine and Biology 01/2012; 12(1). DOI:10.1007/s12522-012-0133-x
Available from: Jennifer E Mersereau
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ABSTRACT: Approximately 10,000 cases of breast cancer are diagnosed in women younger than 40 years of age each year in the United States. This creates a population of young women with breast cancer who may have not started or completed their family. Given that technology and treatment have improved outcomes for these women, quality of life issues, such as fertility preservation, must be considered. This review examines breast cancer patient and physician attitudes toward fertility preservation, ovarian toxicity of chemotherapeutic agents, fertility preservation options for breast cancer patients, and the safety of subsequent pregnancies for these women.
03/2013; 2(1). DOI:10.1007/s13669-012-0035-2
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