Critical appraisal:Goldrat O, Kroman N, Peccatori FA, Cordoba O, Pistilli B, Lidegaard O, et al 2015 2

Critical Appraisal

Article being appraised

Goldrat O, Kroman N, Peccatori FA, Cordoba O, Pistilli B, Lidegaard O, et al. Pregnancy following breast cancer using assisted reproduction and its effect on long-term outcome. Eur J Cancer 2015 Aug;51(12):1490-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26070684.

Applicable clinical question

In cancer survivors does the use of assisted reproduction technologies increase the likelihood of cancer recurrence?

Key Facts

Study Design

cohort study, risk factors

Study aims:

we evaluated the impact of ART on
pregnancy and long-term outcomes of young breast cancer survivors.

Number of Patients:

198

This is a multi-centre retrospective study in which women who were diagnosed with

breast cancer between 2000 and 2009, and had a pregnancy following breast cancer diagnosis
were eligible. Patients were divided into two groups according to whether ART following primary
systemic therapy was performed to achieve pregnancy. We evaluated the association
between ART use and clinic-pathological characteristics, pregnancy outcome and long-term

breast cancer outcome.

Results of outcome(s):

A total of 198 patients were evaluated; of whom 25 underwent ART. No significant
differences in tumour characteristics were observed between both groups, except for histological
grade 3 tumours, which were fewer in the ART group (36% versus 59%, p = 0.033).
Around 90% of patients received primary adjuvant chemotherapy and more than 50% had
an endocrine sensitive disease. Patients in the ART group were older at diagnosis (31.4 versus
33.7 years, p = 0.009), at conception (38 versus 35 years, p < 0.001), and experienced more
miscarriages (23.5 versus 12.6%, p = 0.082). Full term pregnancies were achieved in 77%
and 76% of the spontaneous and ART groups, respectively. Mean follow-up between conception
and last follow-up was 63 and 50 months in the spontaneous and ART groups, respectively
with no difference in breast cancer outcome observed between the two groups
(p = 0.54).

Comments on results:

Conclusion: Pregnancy using ART in women with history of breast cancer is feasible and does
not seem to be detrimental to cancer outcome. Larger studies are needed to further confirm
this observation.