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

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

Are cancer survivors who received cancer treatment less likely than the general population to conceive or give birth after treatment?

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