Mortality among offspring of women diagnosed with cancer: A population‐based cohort study

Abstract

One in five cancers in women is diagnosed prior to and during a woman's fertile years. Our study evaluates mortality risks in offspring of mothers with history of cancer. From the Swedish Multi-generation Register and the Cancer Register, we identified all 174,893 children whose mother had been diagnosed with cancer between 1958 and 2001. We categorized offspring into those born before (>1 year before), around (within 1 year before and after diagnosis) and after (>1 year after) their mother's cancer diagnosis and compared their risks of death (standardized mortality ratios, SMRs) and causes of death to the background population. Overall, offspring of mothers diagnosed with cancer had no increased mortality risk (SMR, 1.00; 95% confidence interval [CI], 0.97-1.03). Increased mortality risks were found in offspring of mothers with tobacco-related cancers (head and neck, thoracic and cervical) (SMR, 1.23; 95% CI, 1.13-1.33), in children born around their mother's diagnosis (SMR, 1.66; 95% CI, 1.25-2.13) and in children born after their mother's hematopoietic cancer diagnosis (SMR, 2.07; 95% CI, 1.10-3.35). Compared to the background population, children born around their mother's diagnosis were more likely to die of congenital and perinatal conditions. Overall, offspring of women diagnosed with cancer were not at increased risk of death, except for certain subgroups. Timing of pregnancy in relation to diagnosis and cancer site modifies mortality risks in the offspring.Eighteen percent of female cancers are diagnosed prior to and during a woman's fertile years.1 About one in 1,000 pregnancies is complicated by a cancer diagnosis 2 and substantial proportion of cancer survivors give birth after their diagnosis (unpublished data). Pregnancy during or after a malignancy has repeatedly been shown not to affect maternal prognosis.3-5 However, exposure to (the effects of) diagnostic investigations, radiation therapy and systemic treatment before and around the time of birth may have adverse effects on the child. 3,4,[6][7][8] Population-based estimates on the outcome of offspring of cancer survivors are lacking. Most studies on childbirth after cancer are hampered by small numbers, as pregnancy during and after cancer is a relatively rare event. As such, these studies are underpowered to pick up small, but real increases in mortality risks in the offspring. Although small effects may not be so relevant on an individual patient level, small increases in risk of complications or death in offspring of cancer patients are important from a public health perspective, especially in the light of the growing number of young cancer survivors and improvement in fertility preservation techniques.With our study, using data of the large population-based Swedish Multi-Generation Registry including over three million families and eleven million individuals, we assess mortality risks in offspring of women with a history of cancer in relation to timing of birth and cancer site. MethodsWe linked data from the Multi-Generation Register (incl...

Parental cancer diagnosis and child mortality—A population-based cohort study in Sweden

“…This population-based cohort study shows that a parental cancer diagnosis was associated with an increased rate of death among children aged [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]; this association appears to be slightly stronger among adolescents. Careful interpretation of the findings is needed because of the low absolute risk of death among these children and lack of information of other potential confounders.…”

“…Verkooijen et al previously reported in a Swedish populationbased cohort study that offspring born over one year before their mother's cancer diagnosis had no significant increase in risk of allcause death up to over 25 years of age [15]. In the present study, we concentrated on children (1-18 years of age) having either a father or a mother with cancer, aiming to first, eliminate the potentially complicating effects of lifestyle and environmental factors on mortality beyond childhood and second, to contrast the impact of paternal and maternal cancer.…”

“…A recent population-based cohort study from Sweden reported a higher risk of death due to perinatal and congenital conditions in children who were born around a cancer diagnosis of the mother [15]. This study specifically hypothesized that carcinogenesis itself or cancer treatment may bear harmful impact on childhood survival, especially during infancy [15]. However, whether the experience of having a parent (father or mother) with cancer is associated with the risk of death beyond infancy has not been investigated in population-based studies.…”

Birth rates among male cancer survivors and mortality rates among their offspring: a population-based study from Sweden

“…This remained constant and was not affected by the timing of birth in relation to the cancer diagnosis. This is starkly different from mothers with cancer, where the timing of birth plays a major role, with offspring born around the time of diagnosis having a 66 % increased risk of death [ 32 ]. This is thought to be related to the intrauterine exposure to cancer treatment (chemotherapeutic agents and radiotherapy).…”

No association between hair cortisol or cortisone and brain morphology in children

“…Maternal cancer diagnosed during pregnancy has been associated with a higher risk of adverse birth outcome such as being born preterm and small for gestational age, and death due to perinatal and congenital conditions (46,47). One recent multicenter study indicated that prenatal exposure to maternal cancer did not lead to cognitive, cardiac, or general health problems among children at the age of 3 years (48).…”