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Pierannunzio D, Maraschini A, Lopez T, Donati S, Amodio R, Bianconi F, Bruni R, Castaing M, Cirilli C, Fantaci G, Guarda L, Iacovacci S, Mangone L, Mazzoleni G, Mazzucco W, Melcarne A, Merlo E, Parazzini F, Peccatori FA, Rugge M, Sampietro G, Scambia G, Scarfone G, Sferrazza A, Stracci F, Torrisi A, Vitale MF, Francisci S. Cancer and Pregnancy: Estimates in Italy from Record-Linkage Procedures between Cancer Registries and the Hospital Discharge Database. Cancers (Basel) 2023; 15:4305. [PMID: 37686581 PMCID: PMC10486505 DOI: 10.3390/cancers15174305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
The aim of this study is to describe the frequency and trend of pregnancy-associated cancer (PAC) in Italy, an increasingly relevant phenomenon due to postponing age at childbirth. To this purpose, a population-based retrospective longitudinal study design based on cohorts of women aged 15-49 diagnosed with cancer and concomitant pregnancy is proposed. The study uses 19 population-based Cancer Registries, covering about 22% of Italy, and linked at an individual level with Hospital Discharge Records. A total of 2,861,437 pregnancies and 3559 PAC are identified from 74,165 women of the cohort with a rate of 1.24 PAC per 1000 pregnancies. The most frequent cancer site is breast (24.3%), followed by thyroid (23.9%) and melanoma (14.3%). The most frequent outcome is delivery (53.1%), followed by voluntary termination of pregnancy and spontaneous abortion (both 12.0%). The trend of PAC increased from 2003 to 2015, especially when the outcome is delivery, thus confirming a new attitude of clinicians to manage cancer throughout pregnancy. This represents the first attempt in Italy to describe PAC from Cancer Registries data; the methodology is applicable to other areas with the same data availability. Evidence from this study is addressed to clinicians for improving clinical management of women with PAC.
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Affiliation(s)
- Daniela Pierannunzio
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, 00162 Rome, Italy
| | - Alice Maraschini
- Technical-Scientific Statistical Service, Italian National Institute of Health, 00162 Rome, Italy
| | - Tania Lopez
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, 00162 Rome, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, 00162 Rome, Italy
| | - Rosalba Amodio
- Clinical Epidemiology and Cancer Registry Unit, Azienda Ospedaliera Universitaria Policlinico (AOUP), 90127 Palermo, Italy
| | | | | | - Marine Castaing
- Siracusa Cancer Registry, Health Unit of Siracusa, 96100 Siracusa, Italy
| | - Claudia Cirilli
- Dipartimento di Epidemiologia e Comunicazione del Rischio, AUSL di Modena, 41126 Modena, Italy
| | | | - Linda Guarda
- SC Osservatorio Epidemiologico ATS Valpadana, 46100 Mantova, Italy
| | - Silvia Iacovacci
- RT LT, Dipartimento di Prevenzione ASL Latina, 04100 Latina, Italy
| | - Lucia Mangone
- European Epidemiology Unit, Gynecologic Oncology Department, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | | | - Walter Mazzucco
- Clinical Epidemiology and Cancer Registry Unit, Azienda Ospedaliera Universitaria Policlinico (AOUP), 90127 Palermo, Italy
| | | | - Elisabetta Merlo
- UOC Epidemiologia, Agenzia per la Tutela della Salute (ATS) della Brianza, 20900 Monza, Italy
| | - Fabio Parazzini
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122 Milano, Italy
| | | | - Massimo Rugge
- Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy
- Veneto Tumor Registry (RTV), Veneto Regional Authority, 35132 Padova, Italy
| | | | - Giovanni Scambia
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica Roma, 00168 Roma, Italy
| | - Giovanna Scarfone
- Gynecologic Oncology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Ausilia Sferrazza
- ASP Ragusa-Dipartimento Medico di Prevenzione, UOSD Registro Tumori, 97100 Ragusa, Italy
| | - Fabrizio Stracci
- Associazione Nazionale dei Registri Tumori—AIRTUM—Public Health Section, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Antonina Torrisi
- Registro Tumori Integrato, Azienda Ospedaliero Universitaria Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | | | - Silvia Francisci
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, 00162 Rome, Italy
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Houlihan OA, Buckley D, Maher GM, McCarthy FP, Khashan AS. Maternal and perinatal outcomes following a diagnosis of Hodgkin lymphoma during or prior to pregnancy: A systematic review. BJOG 2023; 130:336-347. [PMID: 36424902 PMCID: PMC10107208 DOI: 10.1111/1471-0528.17347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The initial peak incidence of Hodgkin lymphoma (HL) occurs during reproductive years. OBJECTIVES Synthesise published literature on the relationship between HL and maternal and perinatal outcomes. SEARCH STRATEGY Systematic search of PubMed/Medline, Cochrane Library, Scopus, Embase and Science Direct from inception to June 2022, supplemented by hand-searching reference lists. SELECTION CRITERIA Two reviewers independently reviewed titles, abstracts and full-text articles. Published studies containing original data were eligible. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and appraised study quality. Outcomes for pregnant women with a previous/current diagnosis of HL were compared separately with women never diagnosed with HL. Where data permitted, meta-analyses of odds ratios and proportions were performed. Certainty of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. MAIN RESULTS Of the 5527 studies identified, 33 met the inclusion criteria. In the groups with HL before pregnancy and HL during pregnancy, adjusted odds ratios were not statistically significant for congenital malformation (aOR 1.7, 95% CI 0.9-3.1, and aOR 1.84, 95% CI 0.81-4.15, respectively), preterm birth (PTB) (aOR 0.99, 95% CI 0.65-1.51, and aOR 6.74, 95% CI 0.52-88.03, respectively) and miscarriage (aOR 0.78, 95% CI 0.55-1.10, and aOR 0.38, 95% CI 0.05-2.72, respectively). The aORs for all other outcomes were not statistically significant, except for blood transfusion (aOR 1.38, 95% CI 1.05-1.82) and venous thromboembolism (VTE) (aOR 7.93, 95% CI 2.97-21.22) in the group for HL during pregnancy. The proportion of anaemia was also increased in this group (69%, 95% CI 57%-80% vs 4%, 95% CI 4%-5%, respectively). The GRADE certainty of findings ranged from low to very low. CONCLUSIONS Rates of most adverse pregnancy outcomes among women with a previous/current HL diagnosis are not increased significantly compared with the general pregnant population. Women with HL diagnosed during pregnancy may have a higher PTB rate and increased likelihood of VTE, anaemia and blood transfusion; however, small study numbers and the low to very low GRADE certainty of findings preclude firm conclusions.
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Affiliation(s)
- Orla A Houlihan
- School of Public Health, University College Cork, Cork, Ireland
| | - Daire Buckley
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Gillian M Maher
- School of Public Health, University College Cork, Cork, Ireland.,INFANT Research Centre, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland.,INFANT Research Centre, University College Cork, Cork, Ireland
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Alfasi A, Ben-Aharon I. Breast Cancer during Pregnancy-Current Paradigms, Paths to Explore. Cancers (Basel) 2019; 11:cancers11111669. [PMID: 31661803 PMCID: PMC6896197 DOI: 10.3390/cancers11111669] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/03/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
Breast cancer is the most common form of malignancy in pregnant women. The prevalence of pregnancy-associated breast cancer (PABC) is up to 0.04% of pregnancies and is expected to rise in developed countries. PABC represents a unique clinical scenario which requires a delicate balance of risks and benefits for both maternal and fetal well-being. Currently, there is paucity of data regarding the short- and long-term outcomes of in-utero exposure to anti-neoplastic agents. In general, when possible, treatment for PABC should follow the same guidelines as in non-pregnant patients. Surgery, including sentinel lymph node biopsy, is possible during all trimesters of pregnancy. Radiotherapy is contraindicated during pregnancy, although it might be considered in highly selected patients based on risk-benefit assessment. Evidence supports that administration of chemotherapy may be safe during the second and third trimesters, with cessation of treatment three weeks prior to expected delivery. Currently, hormonal therapy and anti-HER2 agents are contraindicated during pregnancy and should be postponed until after delivery. Prematurity is associated with worse neonatal and long-term outcomes, and thus should be avoided. While current data on the long-term effects of anti-neoplastic treatments are reassuring, grade of evidence is lacking, hence additional large prospective studies with long-term follow-up are essential to rule out any treatment-induced adverse effects.
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Affiliation(s)
- Ayelet Alfasi
- Division of Oncology, Rambam Health Care Center, Haifa 3109601, Israel.
| | - Irit Ben-Aharon
- Division of Oncology, Rambam Health Care Center, Haifa 3109601, Israel.
- Rapport Faculty of Medicine, Technion, Haifa 3200000, Israel.
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