Originally published as JCO Early Release 10.1200/JCO.2007.15.3130 on December 15 2008

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Reproduction Rates After Cancer Treatment: Experience From the Norwegian Radium Hospital

Milada Cvancarova, Sven Ove Samuelsen, Henriette Magelssen, Sophie Dorothea Fosså

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

Corresponding author: Sophie D. Fosså, MD, The Norwegian Radium Hospital, Montebello, 0310, Oslo, Norway; e-mail: sdf{at}radiumhospitalet.no

Purpose Most studies on postcancer reproduction are limited in patient numbers and lack of control group. We have computed 10-year first postdiagnosis cumulative reproduction rates (10-PDRs) and hazard ratios (HRs) avoiding these limitations.

Patients and Methods Six thousand seventy-one patients with cancer age 15 to 45 years at diagnosis, treated from 1971 to 1997, and 30,355 controls from the general population, all born after 1950, were observed from the true (patients) or assigned (controls) date of diagnosis for a median of 10 years (range, 0 to 35). The primary focus of the study was the 10-PDR before and after 1988+ based on data from the Medical Birth Registry of Norway. Cox proportional hazards regression models were adjusted for age and calendar year at diagnosis, stratified by sex and prediagnosis parenthood.

Results Across all cancer types, HRs of females were approximately 50% lower than those of the controls, the comparable percentage for male patients being approximately 30%, with some improvement after 1988+ for selected diagnoses. The highest 10-PDRs were observed in childless patients, with more favorable HRs in male than in female patients. In survivors with at least one child at diagnosis, the post-1988+ HRs improved significantly in patients with testicular and localized cervical cancer compared to pre-1988+ reproduction, with borderline improvement in localized ovarian cancer.

Conclusion Postcancer reproduction is lower than that of the general population and influenced by sex, age at diagnosis, prediagnosis parenthood, and diagnostic period with more favorable rates in males than in females. Post-1988+ fertility-saving strategies may have improved the reproduction rates for select genital cancers.

published online ahead of print at www.jco.org on December 15, 2008.

Supported by the Lance Armstrong Foundation.

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

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