| Safety of Pregnancy After Primary Breast Carcinoma in Young Women: A Meta-Analysis to Overcome Bias of Healthy Mother Effect Studies. | |
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MedLine Citation:
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PMID: 21411023 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Background: 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. Aim: 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. Methods: 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. Results: 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%. Conclusion: 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. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: 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. |
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Authors:
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Antonis Valachis; Lamprini Tsali; Lorenzo L Pesce; Nikolaos P Polyzos; Charalambos Dimitriadis; Konstantinos Tsalis; Davide Mauri |
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Publication Detail:
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Type: JOURNAL ARTICLE |
Journal Detail:
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Title: Obstetrical & gynecological survey Volume: 65 ISSN: 1533-9866 ISO Abbreviation: - Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2011-3-17 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0401007 Medline TA: Obstet Gynecol Surv Country: - |
Other Details:
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Languages: ENG Pagination: 786-793 Citation Subset: - |
Affiliation:
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*Physician, Onkologkliniken Sörmland, Mälarsjukhuset, Central Hospital of Eskilstuna, Eskilstuna, Sweden; †Researchers and Head of Department of Medical Oncology, General Hospital of Lamia, Lamia, Greece; ‡Researcher, Surgeon, 4th Surgical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece; §Researcher, Department of Radiology, The University of Chicago, Chicago, IL; and ¶Head Researcher, Section of Obstetrics and Gynecology, Panhellenic Association for Continual Medical Research) PACMeR, Athens, Greece. |
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