Pregnancy After Breast Cancer: A Systematic Review and Meta-Analysis
Year: 2021
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: PURPOSE: Many patients and physicians remain concerned about the potential detrimental effects of pregnancy after breast cancer (BC) in terms of reproductive outcomes and maternal safety. This systematic review and meta-analysis aimed at providing updated evidence on these topics. METHODS: A systematic literature review was conducted to identify studies including patients with a pregnancy after BC (PROSPERO number CRD42020158324). Likelihood of pregnancy after BC, their reproductive outcomes, and maternal safety were assessed. Pooled relative risks, odds ratios (ORs), and hazard ratios (HRs) with 95% CIs were calculated using random effects models. RESULTS: Of 6,462 identified records, 39 were included involving 8,093,401 women from the general population and 112,840 patients with BC of whom 7,505 had a pregnancy after diagnosis. BC survivors were significantly less likely to have a subsequent pregnancy compared with the general population (relative risk, 0.40; 95% CI, 0.32 to 0.49). Risks of caesarean section (OR, 1.14; 95% CI, 1.04 to 1.25), low birth weight (OR, 1.50; 95% CI, 1.31 to 1.73), preterm birth (OR, 1.45; 95% CI, 1.11 to 1.88), and small for gestational age (OR, 1.16; 95% CI, 1.01 to 1.33) were significantly higher in BC survivors, particularly in those with previous chemotherapy exposure, compared with the general population. No significantly increased risk of congenital abnormalities or other reproductive complications were observed. Compared to patients with BC without subsequent pregnancy, those with a pregnancy had better disease-free survival (HR, 0.66; 95% CI, 0.49 to 0.89) and overall survival (HR, 0.56; 95% CI, 0.45 to 0.68). Similar results were observed after correcting for potential confounders and irrespective of patient, tumor, and treatment characteristics, pregnancy outcome, and timing of pregnancy. CONCLUSION: These results provide reassuring evidence on the safety of conceiving in BC survivors. Patients' pregnancy desire should be considered a crucial component of their survivorship care plan.
Source: Journal of Clinical Oncology
DOI: 10.1200/jco.21.00535
Authors: Matteo Lambertini, Eva Blondeaux, Marco Bruzzone, Marta Perachino, Richard A. Anderson, Evandro de Azambuja, Philip D. Poorvu, Hee Jeong Kim, Cynthia Villarreal-Garza, Barbara Pistilli, Ines Vaz-Luis, Cristina Saura, Kathryn J. Ruddy, Maria Alice Franzoi, Chiara Sertoli, Marcello Ceppi, Hatem A. Azim, Frederic Amant, Isabelle Demeestere, Lucia Del Mastro, Ann H. Partridge, Olivia Pagani, Fedro A. Peccatori
Institutions: Ospedale Policlinico San Martino, University of Genoa, MRC Centre for Reproductive Health, The Queen's Medical Research Institute, University of Edinburgh, Université Libre de Bruxelles, Institut Jules Bordet, Dana-Farber Cancer Institute, Asan Medical Center, Hospital Zambrano Hellion, Instituto Nacional de Cancerología, Tecnológico de Monterrey, Institut Gustave Roussy, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institute of Oncology, Mayo Clinic, The Netherlands Cancer Institute, Amsterdam University Medical Centers, KU Leuven, Erasmus Hospital, European School of Oncology, University Hospital of Geneva, European Institute of Oncology
Language: English
Topic: Cancer Risks and Factors
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Medical Research Council
Award: G7818575306
OpenAlex ID: W3173897906