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Open Access Research article

A population-based study of rates of childbirth in recurrence-free female young adult survivors of Non-gynecologic malignancies

Nancy N Baxter123*, Rinku Sutradhar27, M Elizabeth DelGuidice4, Shawn Forbes5, Lawrence F Paszat2367, Andrew S Wilton2, David Urbach238 and Linda Rabeneck1279

Author Affiliations

1 Department of Surgery and Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, 30 Bond Street 16CC-40, Toronto, ON, M5B 1W8, Canada

2 Institute for Clinical Evaluative Sciences, Toronto, Canada

3 Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada

4 Department of Family and Community Medicine, University of Toronto, Toronto, Canada

5 Department of Surgery, McMaster University, Hamilton, Canada

6 Odette Cancer Centre, Sunnybrook Health Sciences Centre Toronto, Toronto, Canada

7 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

8 Department of Surgery, University Health Network, Toronto, ON, Canada

9 Cancer Care Ontario, Toronto, Canada

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BMC Cancer 2013, 13:30  doi:10.1186/1471-2407-13-30

Published: 23 January 2013

Abstract

Background

Fertility is an important issue for long-term survivors of malignancies developing during reproductive years. We designed a population-based study to investigate childbirth in female young adult survivors of non-gynecologic malignancies.

Methods

Women 20–34 years diagnosed with non-gynecologic malignancies in Ontario from 1992–1999 who lived at least 5 years recurrence-free were identified using the Ontario Cancer Registry and age matched to 5 randomly selected cancer-free women. Childbirth was determined through hospital discharge data. Time-to-childbirth was compared between survivors and controls using Cox proportional hazard regression for all subjects and stratified by prior childbirth and disease site.

Results

3,285 survivors and 15,118 control women had a median of 12 years observation. 1,194 survivors and 6,049 controls experienced childbirth to the end of observation (March 2011). Overall, survivors experienced a longer time to childbirth than controls (HR 0.92, 95% CI 0.87-0.98), however this was limited to survivors with prediagnosis childbirth (HR 0.76, 95% CI 0.66-0.86). Survivors with no prediagnosis childbirth experienced a similar time to childbirth (HR 1.00, 95% CI 0.93-1.08) as control women. Differences between survivors and controls varied by type of malignancy; notably for those with prediagnosis childbirth, survivors of breast cancer (HR 0.45, 95% CI 0.29-0.68) and Hodgkin Disease (HR 0.57, 95% CI 0.36-0.91) had lower rates of postdiagnosis childbirth than controls.

Conclusions

Long-term female young adult survivors of malignancies are less likely than controls to have childbirth after diagnosis; the overall effect is small and is influenced by prediagnosis childbirth and malignancy type.

Keywords:
Cancer survivorship; Young adults; Pregnancy outcomes; Cohort study