Critical appraisal:Gerstl B, Sullivan E, Ives A, Saunders C, Wand H, Anazodo A 2018

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Critical Appraisal

Article being appraised

Gerstl B, Sullivan E, Ives A, Saunders C, Wand H, Anazodo A. Pregnancy Outcomes After a Breast Cancer Diagnosis: A Systematic Review and Meta-analysis. Clin Breast Cancer 2018 Feb;18(1):e79-e88 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28797766.


Applicable clinical question

Key Facts

Study Design

systematic review — cohort, case-control, population based

Study aims:

The aim of the present review was to report on the pregnancy and reproductive outcomes after BC treatment for women of reproductive age

Number of Patients:

Not applicable

Included 16 studies - collectively representing ~3 million women.

In the matched cohort and case-control studies subgroup analyses n = 1287.

In the population-based studies n = 711.
Reported outcome(s):

Pregnancy (& miscarriage, termination)

Results of outcome(s):

-The mean interval to the first pregnancy after BC treatment was 29 months (range, 11-63 months), and the mean interval to the first birth after BC treatment was 40 months (range, 10-228 months).
-Subgroup: Women who had received systemic therapy after surgery had an overall pooled estimate of 14% (95%CI=0.12-0.16; I^2 = 95.4%) of becoming pregnant. Of those who became pregnant, 12% (95%CI= 0.08-0.16; I^2 = 65.9%) experienced a miscarriage and 21% (95%CI = 0.16-0.26; I^2 = 45.9%) terminated the pregnancy.
-Population-based: Estimated pooled pregnancy rate was 3% (95% CI= 0.02-0.03; I^2 = 85.1%) for women who became pregnant after BC treatment (median age 31-33 years).
The pregnancy rate after BC treatment for survivors was on average 40% lower than the general population pregnancy rate.

Comments on results:

- analyses done on summary data (not individual level) - and with it associated challenges in regards to inconsistent reporting etc.

Includes an economic evaluation

no

Evidence ratings

Level of evidence

III-3

Risk of bias
Low risk of bias Comments: A systematic review and meta analyses of observational studies (not intervention/ level II per se)
Result of appraisal

Jutta's tick icon.png Included



Comments

Although a review, as this report on new data I have said include... but wasn't sure based on the criteria above

Completed by

Dr Michelle Peate

Jutta's tick icon.png This appraisal has been completed.


Article
Gerstl B, Sullivan E, Ives A, Saunders C, Wand H, Anazodo A. Pregnancy Outcomes After a Breast Cancer Diagnosis: A Systematic Review and Meta-analysis. Clin Breast Cancer 2018 Feb;18(1):e79-e88 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28797766.
Assigned to
User:Michelle.peate
Topic area
Guidelines:COSA:Cancer fertility preservation guidelines/Impact of cancer on fertility
Clinical question
Form
Form:Critical appraisal


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