Pregnancy after breast cancer: population based studyBMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39035.667176.55 (Published 25 January 2007) Cite this as: BMJ 2007;334:194
- Angela Ives, doctoral scholar1,
- Christobel Saunders, professor of surgical oncology1,
- Max Bulsara, research fellow2,
- James Semmens, professor of health services research3
- 1School of Surgery and Pathology (M507), University of Western Australia, Crawley, Western Australia 6009
- 2School of Population Health (M431), University of Western Australia, Crawley, Western Australia 6009
- 3School of Public Health, Curtin University of Technology, Bentley, Western Australia 6845
- Correspondence to: A Ives
- Accepted 3 November 2006
Objectives To identify women who survived breast cancer and subsequently conceived and to determine the rate of pregnancy (proportion), management, outcome of the cancer, and outcome of the first subsequent pregnancy.
Design Population based descriptive study with cases identified from the Western Australian data linkage system and validated by review of medical charts. Supplementary data obtained from hospital and clinician records.
Setting Western Australia, 1982-2003.
Participants Women aged <45 with a diagnosis of breast cancer who subsequently conceived.
Main outcome measures Pregnancy outcome and rate, survival, time from diagnosis to pregnancy.
Results Sixty two (54%) women with a diagnosis of breast cancer who subsequently conceived did so less than two years after their diagnosis: 29 of them had an abortion, 27 had a live birth, and six miscarried. Within a proportional hazards regression model subsequent pregnancy was associated with improved overall survival (hazard ratio 0.59, 95% confidence interval 0.37 to 0.95). When the model was stratified by time from diagnosis subsequent pregnancy was associated with improved overall survival in women who waited at least 24 months to conceive (0.48, 0.27 to 0.83) and a non-significant protective effect was seen for women who waited at least six months to become pregnant.
Conclusions Our study does not support the current medical advice given to premenopausal women with a diagnosis of with breast cancer to wait two years before attempting to conceive. This recommendation may be valid for women who are receiving treatment or have systemic disease at diagnosis, but for women with localised disease early conception, six months after completing their treatment, is unlikely to reduce survival.
We thank the Information, Collection and Management Branch, Western Australian Department of Health (including the data linkage unit and cancer registry) for helping to identify potential cases for the study and the clinicians and their staff who freely gave of their time, effort, and records to enable patient data to be extracted.
Contributors: AI, CS, and JS were involved in the conception and design of the study and interpretation of the data. AI and MB undertook the data analysis. AI drafted the article and all authors revised and approved the final version. CS is guarantor.
Funding: Raine Medical Research Foundation, Nedlands, Western Australia; Friends of Breast Cancer Research, Perth, Western Australia; Susan G Komen Breast Cancer Foundation, Dallas, Texas, USA; National Breast Cancer Foundation, Sydney, Australia.
Competing interests: None declared.
Ethical approval: University of Western Australia, all hospitals in Western Australia from which data were collected, and the confidentiality of health information committee (CHIC) at the Western Australian Department of Health.
- Accepted 3 November 2006