Critical appraisal:Kroman N, Jensen MB, Wohlfahrt J, Ejlertsen B, Danish Breast Cancer Cooperative Group 2008

From Cancer Guidelines Wiki

Critical Appraisal

Article being appraised

Kroman N, Jensen MB, Wohlfahrt J, Ejlertsen B, Danish Breast Cancer Cooperative Group. Pregnancy after treatment of breast cancer--a population-based study on behalf of Danish Breast Cancer Cooperative Group. Acta Oncol 2008;47(4):545-9 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18465320.


Applicable clinical question

Key Facts

Study Design

cohort study, risk factors

Study aims:

An update on the question of prognostic influence of pregnancy subsequent to breast cancer treatment (additional 10 years of inclusion and observation)

Number of Patients:

10236

- Danish population-based cohort study

- Breast cancer patients <45 years

- Completely resected unilateral invasive carcinoma of the breast and no metastases
Reported outcome(s):

- Pregnancy
- Node positivity
- Size of tumour
- Risk of death

Results of outcome(s):

- 371 women (3.6%) experienced 465 pregnancies
- Significantly fewer women with subsequent pregnancy were node positive (p<0.001) and tendancy to smaller tumours (p = 0.09)
- Women with full-term pregnancy after treatment of breast cancer had significantly reduced risk of dying (RR 0.73, 95%CI 0.54 - 0.99, p=0.04) compared to other women with breast cancer
- Women experiencing miscarriage were also found to have a significant reduced risk of death (RR 0.35, 95% CI 0.15 - 0.85, P<0.05)

Comments on results:

- Cohort extended from original 5752 patients to 10236 and additional follow-up of 10 years for the original cohort

Includes an economic evaluation

no

Evidence ratings

Level of evidence

III-2

Risk of bias
Moderate risk of bias Comments: Please see Analysis bias


Size of effect
1 Reason for decision:
Relevance of evidence
1 Additional comments: Risk of death very relevant
Result of appraisal

Jutta's tick icon.png Included



Comments

- Multivariate analysis showed that the effect of subsequent pregnancy was not significantly modified by age, tumour size, nodal status, status as parous/nulliparous before diagnosis, time since most recent previous pregnancy before diagnosis, age at subsequent pregnancy, or time to subsequent pregnancy)


Property "Appraisal completed by" (as page type) with input value "User:" contains invalid characters or is incomplete and therefore can cause unexpected results during a query or annotation process.

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


Article
Kroman N, Jensen MB, Wohlfahrt J, Ejlertsen B, Danish Breast Cancer Cooperative Group. Pregnancy after treatment of breast cancer--a population-based study on behalf of Danish Breast Cancer Cooperative Group. Acta Oncol 2008;47(4):545-9 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18465320.
Assigned to
User:Sally.reid
Topic area
Guidelines:COSA:Cancer fertility preservation guidelines/Preconception assessment for cancer survivors
Clinical question
Form
Form:Critical appraisal


Section below only relevant for Cancer Council Project Officer

Edit appraisal assignment