Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
Breast J. 2010 Jul-Aug;16(4):404-11. doi: 10.1111/j.1524-4741.2010.00939.x. Epub 2010 May 26.
The impact of treatment on subsequent fertility and the safety of childbearing are major complicating factors for young women diagnosed with breast cancer. As national data indicate women are postponing first pregnancy to older ages; therefore, many young patients are seeking clinical guidance regarding the safety of conception and treatment options that may not prevent subsequent pregnancy. Newly developed chemotherapy protocols of brief duration have improved life expectancy enabling some women to consider childbearing. This study was conducted to compare prognosis among breast cancer patients with and without a subsequent pregnancy. Medical record review of female members of a Northern California prepaid health care plan enabled the identification of 107 women with one or more subsequent pregnancies and 344 cases without a pregnancy, who were diagnosed between 1968 and 1995. Sets were matched on age, year and stage at diagnosis, months of survival and recurrence status at conception. Among the matched sets, neither risk of recurrence nor death differed significantly by subsequent pregnancy history during an average 12 years of follow-up (adjusted hazard ratio [HR] recurrence: 1.2 [0.8, 2.0]; adjusted HR death: 1.0 [0.6, 1.9]). Women interested in preserving their fertility and considering pregnancy are a self-selected population; therefore, to reduce potential bias, cases were matched on recurrence status at time of conception. Although the number of cases was limited, subgroup analyzes indicated a small, nonsignificant adverse effect among women who conceived within 12 months of diagnosis. This analysis of carefully matched cases provides reassurance that long-term prognosis was not adversely affected by subsequent pregnancy.
治疗对后续生育能力的影响以及生育的安全性是年轻乳腺癌患者的主要复杂因素。由于国家数据表明女性首次怀孕的年龄越来越晚；因此，许多年轻患者正在寻求关于受孕安全性和可能无法预防后续妊娠的治疗选择的临床指导。新开发的短疗程化疗方案提高了预期寿命，使一些女性能够考虑生育。这项研究旨在比较有后续妊娠和无后续妊娠的乳腺癌患者的预后。对加利福尼亚州北部一家预付医疗保健计划的女性成员的医疗记录进行回顾，确定了 107 名有一次或多次后续妊娠的女性和 344 名无妊娠的女性，她们在 1968 年至 1995 年期间被诊断出患有乳腺癌。这些病例集根据年龄、诊断时的年份和阶段、存活月份和受孕时的复发情况进行了匹配。在平均 12 年的随访中，根据后续妊娠史，匹配组之间的复发风险或死亡风险没有显著差异（调整后的复发风险比[HR]：1.2[0.8, 2.0]；调整后的死亡 HR：1.0[0.6, 1.9]）。对保留生育能力并考虑怀孕的女性感兴趣的是一个自我选择的人群；因此，为了减少潜在的偏见，在受孕时的复发情况上对病例进行了匹配。尽管病例数量有限，但亚组分析表明，在诊断后 12 个月内怀孕的女性中，风险略小，但无统计学意义。对精心匹配的病例进行的这项分析使人们放心，即后续妊娠并未对长期预后产生不利影响。
