Emily K Hartman1, Guy D Eslick2. 1. The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Level 3, Clinical Building, P.O. Box 63, Penrith, NSW, 2751, Australia. 2. The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Level 3, Clinical Building, P.O. Box 63, Penrith, NSW, 2751, Australia. guy.eslick@sydney.edu.au.
Abstract
OBJECTIVE: Previous meta-analyses have examined the prognosis of women with pregnancy-associated breast cancer (PABC) as well as pregnancy that follows breast cancer diagnosis. Since then, many additional studies have been performed. We conducted an updated meta-analysis to examine the prognosis for women who become pregnant before, during and after a diagnosis of breast cancer. We also performed analyses on the various subgroups within PABC such as pregnancy and postpartum cases, as well as on time periods postpartum. METHODS: We identified studies that reported on overall (OS) and disease-free survival (DFS) in patients diagnosed with breast cancer during pregnancy or up to 5 years postpartum from four electronic databases. We also identified studies that reported on OS and DFS where pregnancy up to 5 years occurred after a breast cancer diagnosis. RESULTS: 41 studies met our inclusion criteria (cases = 4929; controls = 61,041) for pregnancy occurring during or before breast cancer diagnosis. There was an overall increased risk of death amongst patients compared to non-pregnant controls [HR 1.57; 95 % CI 1.35-1.82]. Subgroup analysis indicated poor survival outcomes for those diagnosed either during pregnancy or postpartum (PABC) [HR 1.46; 95 % CI 1.17-1.82] as well as those diagnosed during pregnancy alone [HR 1.47; 95 % CI 1.04-2.08]. Those diagnosed postpartum had the poorest overall survival [HR 1.79; 95 % CI 1.39-2.29]. Similarly, patients with PABC had decreased DFS compared to controls [HR 1.51; 95 % CI 1.22-1.88]. Those diagnosed postpartum were the most at risk of disease progression or relapse [HR 1.86; 95 % CI 1.17-2.93]. 19 studies met our inclusion criteria (cases = 1829; controls = 21,907) for pregnancy following breast cancer diagnosis. Such women had a significantly reduced risk of death compared to those who did not become pregnant [pHR 0.63; 95 % CI 0.51-0.79]. A subgroup analysis to account for the "healthy mother effect" generated similar results [pHR 0.65; 95 % CI 0.52-0.81]. CONCLUSION: Pregnancy that occurs before or concurrently with a diagnosis of breast cancer is more likely to result in death and decreased disease-free survival. On the other hand, pregnancy occurring after a breast cancer diagnosis reduces the risk of death.
OBJECTIVE: Previous meta-analyses have examined the prognosis of women with pregnancy-associated breast cancer (PABC) as well as pregnancy that follows breast cancer diagnosis. Since then, many additional studies have been performed. We conducted an updated meta-analysis to examine the prognosis for women who become pregnant before, during and after a diagnosis of breast cancer. We also performed analyses on the various subgroups within PABC such as pregnancy and postpartum cases, as well as on time periods postpartum. METHODS: We identified studies that reported on overall (OS) and disease-free survival (DFS) in patients diagnosed with breast cancer during pregnancy or up to 5 years postpartum from four electronic databases. We also identified studies that reported on OS and DFS where pregnancy up to 5 years occurred after a breast cancer diagnosis. RESULTS: 41 studies met our inclusion criteria (cases = 4929; controls = 61,041) for pregnancy occurring during or before breast cancer diagnosis. There was an overall increased risk of death amongst patients compared to non-pregnant controls [HR 1.57; 95 % CI 1.35-1.82]. Subgroup analysis indicated poor survival outcomes for those diagnosed either during pregnancy or postpartum (PABC) [HR 1.46; 95 % CI 1.17-1.82] as well as those diagnosed during pregnancy alone [HR 1.47; 95 % CI 1.04-2.08]. Those diagnosed postpartum had the poorest overall survival [HR 1.79; 95 % CI 1.39-2.29]. Similarly, patients with PABC had decreased DFS compared to controls [HR 1.51; 95 % CI 1.22-1.88]. Those diagnosed postpartum were the most at risk of disease progression or relapse [HR 1.86; 95 % CI 1.17-2.93]. 19 studies met our inclusion criteria (cases = 1829; controls = 21,907) for pregnancy following breast cancer diagnosis. Such women had a significantly reduced risk of death compared to those who did not become pregnant [pHR 0.63; 95 % CI 0.51-0.79]. A subgroup analysis to account for the "healthy mother effect" generated similar results [pHR 0.65; 95 % CI 0.52-0.81]. CONCLUSION: Pregnancy that occurs before or concurrently with a diagnosis of breast cancer is more likely to result in death and decreased disease-free survival. On the other hand, pregnancy occurring after a breast cancer diagnosis reduces the risk of death.
Entities:
Keywords:
Breast cancer; Gestation; Meta-analysis; PABC; Postpartum; Pregnancy; Pregnancy-associated breast cancer
Authors: Ciara C O'Sullivan; Sheeba Irshad; Zheyu Wang; Zhuojun Tang; Christopher Umbricht; Gary L Rosner; Mindy S Christianson; Vered Stearns; Karen Lisa Smith Journal: Breast Cancer Res Treat Date: 2020-03-11 Impact factor: 4.872
Authors: Alexandra Thomas; Anthony Rhoads; Jonathan Suhl; Kristin M Conway; William G Hundley; Lacey R McNally; Jacob Oleson; Susan A Melin; Charles F Lynch; Paul A Romitti Journal: Clin Breast Cancer Date: 2020-02-04 Impact factor: 3.225
Authors: Vânia Gonçalves; Janella Hudson; Maria Cristina Canavarro; Julie Morris; M Catherine Lee; Kristine A Donovan; Steven K Sutton; Susan T Vadaparampil; Gwendolyn P Quinn Journal: Breast Date: 2018-04-16 Impact factor: 4.380
Authors: J Alejandro Rauh-Hain; Jose Zubizarreta; Roni Nitecki; Alexander Melamed; Shuangshuang Fu; Kirsten Jorgensen; Paula C Brady; Valerie L Baker; Mariana Chavez-MacGregor; Sharon H Giordano; Nancy L Keating Journal: Cancer Date: 2022-06-29 Impact factor: 6.921
Authors: Lisa Prior; Richard O'Dwyer; Abdul Rehman Farooq; Megan Greally; Cian Ward; Connor O'Leary; Razia Aslam; Waseem Darwish; Nada Ahmed; Elly Che Othman; Geoffrey Watson; Deirdre Kelly; Jack Gleeson; Lisa Kiely; Anees Hassan; Elaine M Walsh; David O'Reilly; Alfred Jones; Hannah Featherstone; Marvin Lim; Hazel Murray; Bryan T Hennessy; Lillian M Smyth; Gregory Leonard; Liam Grogan; Oscar Breathnach; Paula Calvert; Anne M Horgan; Linda Coate; Emmet J Jordan; Deirdre O'Mahony; Rajnish Gupta; Maccon M Keane; Jennifer Westrup; Karen Duffy; Miriam O'Connor; Patrick G Morris; M John Kennedy; Seamus O'Reilly; John McCaffrey; Catherine M Kelly; Desmond Carney; Giuseppe Gullo; John Crown; Michaela J Higgins; Paul M Walsh; Janice M Walshe Journal: Breast Cancer Res Treat Date: 2021-06-14 Impact factor: 4.872
Authors: Nikita M Shah; Dana M Scott; Pridvi Kandagatla; Molly B Moravek; Erin F Cobain; Monika L Burness; Jacqueline S Jeruss Journal: Ann Surg Oncol Date: 2019-01-24 Impact factor: 5.344
Authors: Katarzyna J Jerzak; Nechama Lipton; Sharon Nofech-Mozes; Dina Boles; Elzbieta Slodkowska; Gregory R Pond; Ellen Warner Journal: Breast Cancer Res Treat Date: 2021-07-27 Impact factor: 4.872
Authors: Javaid Iqbal; Eitan Amir; Paula A Rochon; Vasily Giannakeas; Ping Sun; Steven A Narod Journal: JAMA Oncol Date: 2017-05-01 Impact factor: 31.777