Incidence and outcomes of pregnancy‐associated cancer in Australia, 1994–2008: a population‐based linkage study

Abstract

ObjectiveTo determine trends in pregnancy-associated cancer and associations between maternal cancer and pregnancy outcomes.DesignPopulation-based cohort study.SettingNew South Wales, Australia, 1994–2008.PopulationA total of 781 907 women and their 1 309 501 maternities.MethodsCancer and maternal information were obtained from linked cancer registry, birth and hospital records for the entire population. Generalised estimating equations with a logit link were used to examine associations between cancer risk factors and pregnancy outcomes.Main outcome measuresIncidence of pregnancy-associated cancer (diagnosis during pregnancy or within 12 months of delivery), maternal morbidities, preterm birth, and small- and large-for-gestational-age (LGA).ResultsA total of 1798 new cancer diagnoses were identified, including 499 during pregnancy and 1299 postpartum. From 1994 to 2007, the crude incidence rate of pregnancy-associated cancer increased from 112.3 to 191.5 per 100 000 maternities (P < 0.001), and only 14% of the increase was explained by increasing maternal age. Cancer diagnosis was more common than expected in women aged 15–44 years (observed-to-expected ratio 1.49; 95% CI 1.42–1.56). Cancers were predominantly melanoma (33.3%) and breast cancer (21.0%). Women with cancer diagnosed during pregnancy had high rates of labour induction (28.5%), caesarean section (40.0%) and planned preterm birth (19.7%). Novel findings included a cancer association with multiple pregnancies (adjusted odds ratio 1.52, 95% CI 1.13–2.05) and LGA (aOR 1.47, 95% CI 1.14–1.89).ConclusionsPregnancy-associated cancers have increased, and this increase is only partially explained by increasing maternal age. Pregnancy increases women’s interaction with health services and the possibility for diagnosis, but may also influence tumour growth.

High-grade cervical dysplasia in pregnancy – psychological and medical challenges

“…For a cancer to be categorized as pregnancyassociated neoplasia, it must be diagnosed during pregnancy or up to 1 year after delivery. The incidence rate for this type of cancer ranges from 17 to 38 cases/100.000 births (2)(3)(4).…”

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“…The average age of women with PABC is between 32 and 38 years [5,9,10]. The diagnosis of PABC is expected to become more frequent, since the percentage of women aged 35 years and over at first birth has increased, underscoring the increasing trend for women to delay childbearing [3,6,7,11]. It is noted that breast cancer diagnosed within 5 years postpartum has a 2.8 times higher risk for metastasis and 2.7 times higher mortality risk than that in nulliparous women [12,13].…”

“…The incidence of PABC is increasing [2] and at a reported range of 1:3,000 to 1:10,000 pregnancies [3][4][5][6][7] it is presently the most frequently diagnosed type of cancer during pregnancy [8]. The average age of women with PABC is between 32 and 38 years [5,9,10].…”

The influence of pregnancy, parity, and sex on melanoma prognosis

“…Melanoma during pregnancy has an estimated incidence of 0.14-2.8 cases per 1000 live births (17,18). A recent Australian population-based study estimated that the incidence of melanoma occurring during pregnancy was more than twice that of the general population (19).…”

“…In Germany, 1% of female melanoma patients were pregnant at the time of diagnosis (21). Melanoma has recently been ranked as the leading cause of cancer during pregnancy in both Norway (22) and Australia (19). This makes it a significant public health issue affecting a variety of medical specialties including Dermatology, Oncology, General Practice, and Obstetrics and Gynaecology.…”