A population-based study of rates of childbirth in recurrence-free female young adult survivors of Non-gynecologic malignancies
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
BMC Cancer 2013, 13:30 doi:10.1186/1471-2407-13-30Published: 23 January 2013
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.
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.
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.
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.