Critical appraisal:Anderson RA, Brewster DH, Wood R, Nowell S, Fischbacher C, Kelsey TW, et al 2018
Anderson RA, Brewster DH, Wood R, Nowell S, Fischbacher C, Kelsey TW, et al. The impact of cancer on subsequent chance of pregnancy: a population-based analysis. Hum Reprod 2018 Jul 1;33(7):1281-1290 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29912328.
- Are cancer survivors who received cancer treatment less likely than the general population to conceive or give birth after treatment?
To study if women achieved pregnancy after cancer diagnosis on a population level
There were 30811 match controls
Total number of pregnancies in cancer group. Calculated standardized incidence ratio using expected pregnancies based upon rates in the general population. The overall impact of each cancer diagnostic group was calculated from the number of women with each diagnosis and its impact, as a proportion of the total pregnancy deficit.
Overall the cancer survivors achieved a lower than expected number of pregnancies compared to the general population of women: 6627 observed compared to 10 736 expected pregnancies, SIR 0.62 (95% CI: 0.60, 0.63: Table I). Thus cancer survivors were approximately 38% less likely to achieve pregnancy after diagnosis. SIR was significantly reduced for women with all cancer types with the exception of liver cancer, which was the least prevalent. SIR ranged from 0.34 (0.31–0.37) for women with cervical cancer, to 0.87 (0.84–0.90) for skin cancers.
There was an overall reduction in likelihood of pregnancy after diagnosis. The reduction was seen in all groups by age at diagnosis and across the diagnostic spectrum, even in cancers which are predominantly managed surgically, although treatment with chemotherapy and radiotherapy were both shown to have importanteffects. There was no marked variation by deprivation index.
No increased risk of miscarriage or still birth among first pregnancies achieved after a cancer diagnosis.
The slightly lower proportion of pregnancies among women with previous cancer that end in a termination of pregnancy may reflect more active planning of pregnancies in the cancer group, increased use of
contraception, or continuation of more unplanned pregnancies.
|High risk of bias||Comments:|
- Anderson RA, Brewster DH, Wood R, Nowell S, Fischbacher C, Kelsey TW, et al. The impact of cancer on subsequent chance of pregnancy: a population-based analysis. Hum Reprod 2018 Jul 1;33(7):1281-1290 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29912328.
- Assigned to
- Topic area
- Guidelines:COSA:Cancer fertility preservation guidelines/Impact of cancer on fertility
- Clinical question
Section below only relevant for Cancer Council Project Officer