Being diagnosed with cancer during pregnancy or up to 1 year postpartum is associated with an increased risk of death, according to research published in JAMA Oncology.
The study showed that patients diagnosed with cancer during pregnancy or up to 1 year after delivery had a 57% higher risk of death than patients diagnosed with cancer outside of pregnancy or the postpartum period. In addition, the risk of death varied by cancer type.
This retrospective study included 24,307 premenopausal cancer patients — 1014 who were diagnosed during pregnancy, 3074 who were diagnosed up to 1 year after delivery, and 20,219 who were diagnosed outside of pregnancy or the postpartum period.
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Breast cancer was the most common cancer in patients diagnosed during pregnancy (26%) and those diagnosed remote from pregnancy (30%). Thyroid cancer was the most common cancer in patients diagnosed during the postpartum period (24%).
When the researchers analyzed all cancer sites together, the 1-year survival rates were similar for patients diagnosed with cancer during pregnancy (97%), up to 1 year postpartum (96%), or remote from pregnancy (98%).
However, 5-year survival rates were lower for patients diagnosed during pregnancy (87%) or during the postpartum period (89%), compared with patients diagnosed remote from pregnancy (93%).
In an adjusted analysis, patients diagnosed with cancer either during pregnancy or postpartum had a 57% higher risk of death during the mean follow-up of 6.3 years (adjusted hazard ratio [aHR], 1.57; 95% CI, 1.42-1.74).
The risk of death was 79% higher for patients diagnosed with cancer during pregnancy (aHR, 1.79; 95% CI, 1.51-2.13) and 49% higher for those diagnosed during the 1-year postpartum period (aHR, 1.49; 95% CI, 1.33-1.67), compared with patients diagnosed remote from pregnancy.
The researchers also observed an increased mortality risk for patients diagnosed with breast cancer (aHR, 2.01; 95% CI, 1.58-2.56), ovarian cancer (aHR, 2.60; 95% CI, 1.12-6.03), and stomach cancer (aHR, 10.37; 95% CI, 3.56-30.24) during pregnancy.
For patients diagnosed with cancer during the postpartum period, there was an increased mortality risk among those with brain cancer (aHR, 2.75; 95% CI, 1.28-5.90), breast cancer (aHR, 1.61; 95% CI, 1.32-1.95), and melanoma (aHR, 1.84; 95% CI, 1.02-3.30).
“This population-based cohort study found that pregnancy-associated cancers had an overall increased mortality compared with cancer occurring remotely from pregnancy, and death rates varied greatly depending on cancer site and timing of diagnosis (pregnancy vs postpartum),” the researchers concluded. “More research on each cancer site is required to provide robust evidence to guide counseling and clinical care of affected patients.”
Reference
Cairncross ZF, Shack L, Nelson G, et al. Long-term mortality in individuals diagnosed with cancer during pregnancy or postpartum. JAMA Oncol. Published online April 6, 2023. doi:10.1001/jamaoncol.2023.0339
