Originally published as JCO Early Release 10.1200/JCO.2008.17.4110 on November 24 2008

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Cause-Specific Survival for Women Diagnosed With Cancer During Pregnancy or Lactation: A Registry-Based Cohort Study

Hanne Stensheim, Bjørn Møller, Tini van Dijk, Sophie D. Fosså

From the Cancer Registry of Norway; Department of Clinical Cancer Research, Division of Cancer Medicine and Radiotherapy, Norwegian Radium Hospital, Rikshospitalet University Hospital, Montebello; and the Faculty Division the Norwegian Radium Hospital, University of Oslo, Oslo, Norway

Corresponding author: Hanne Stensheim, MD, Cancer Registry of Norway, Postboks 5313 Majorstuen, N-0304 Oslo, Norway; e-mail: hanne.stensheim{at}kreftregisteret.no

Purpose To assess if cancers diagnosed during pregnancy or lactation are associated with increased risk of cause-specific death.

Patients and Methods In this population-based cohort study using data from the Cancer Registry and the Medical Birth Registry of Norway, 42,511 women, age 16 to 49 years and diagnosed with cancer from 1967 to 2002, were eligible. They were grouped as not pregnant (reference), pregnant, or lactating at diagnosis. Cause-specific survival for all sites combined, and for the most frequent malignancies, was investigated using a Cox proportional hazards model. An additional analysis with time-dependent covariates was performed for comparison of women with and without a postcancer pregnancy. The multivariate analyses were adjusted for age at diagnosis, extent of disease, and diagnostic periods.

Results For all sites combined, no intergroup differences in cause-specific death were seen, with hazard ratio (HR) of 1.03 (95% CI, 0.86 to 1.22) and HR 1.02 (95% CI, 0.86 to 1.22) for the pregnant and lactating groups, respectively. Patients with breast (HR, 1.95; 95% CI, 1.36 to 2.78) and ovarian cancer (HR, 2.23; 95% CI, 1.05 to 4.73) diagnosed during lactation had an increased risk of cause-specific death. Diagnosis of malignant melanoma during pregnancy slightly increased this risk. For all sites combined, the risk of cause-specific death was significantly decreased for women who had postcancer pregnancies.

Conclusion In general, the diagnosis of most cancer types during pregnancy or lactation does not increase the risk of cause-specific death. Breast and ovarian cancer diagnosed during lactation represents an exception. We confirmed the "healthy mother effect" for women with a postcancer pregnancy.

published online ahead of print at www.jco.org on November 24, 2008

Supported by EXTRA funds from the Norwegian Foundation for Health and Rehabilitation, through the Norwegian Cancer Society.

Presented in part at ECCO 14, Barcelona, Spain, September 23-27, 2007.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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