Department of Medical Oncology, Jules Bordet Institute, Brussels, Belgium.
Eur J Cancer. 2011 Jan;47(1):74-83. doi: 10.1016/j.ejca.2010.09.007. Epub 2010 Oct 11.
Due to the rising trend of delaying pregnancy to later in life, more women are diagnosed with breast cancer before completing their families. Therefore, enquiry into the feasibility and safety of pregnancy following breast cancer diagnosis is on the rise. Available evidence suggests that women with a history of breast cancer are frequently advised against future conception for fear that pregnancy could adversely affect their breast cancer outcome. Hence, we conducted a meta-analysis to understand the effect of pregnancy on overall survival of women with a history of breast cancer.
Two of the authors independently performed a literature search up to September 2009 with no language restrictions. Eligible studies were published retrospective control-matched, population-based and hospital-based studies that have addressed the impact of pregnancy on the overall survival of women with history of breast cancer. Pooling of data was done using the random effect model. Unpublished statistics from three studies were obtained to perform further subgroup and sensitivity analyses. This included examining the effect of pregnancy according to age at diagnosis, healthy mother effect, type of study, nodal status and other parameters.
Fourteen studies were included in this meta-analysis (1244 cases and 18,145 controls). Women who got pregnant following breast cancer diagnosis had a 41% reduced risk of death compared to women who did not get pregnant [PRR: 0.59 (90% confidence interval (CI): 0.50-0.70)]. This difference was seen irrespective of the type of the study and particularly in women with history of node-negative disease. In a subgroup analysis, we compared the outcome of women with history of breast cancer who became pregnant to breast cancer patients who did not get pregnant and were known to be free of relapse. In this analysis, we did not find significant differences in survival between either group [PRR: 0.85; 95% CI: 0.53-1.35].
This study confirms that pregnancy in women with history of breast cancer is safe and does not compromise their overall survival. Hence, breast cancer survivors should not be denied the opportunity of future conception.
由于推迟生育至晚年的趋势不断上升，更多女性在完成家庭生育任务前被诊断患有乳腺癌。因此，人们对乳腺癌诊断后妊娠的可行性和安全性的关注度日益提高。现有证据表明，由于担心妊娠会对乳腺癌的治疗结果产生不利影响，许多曾患有乳腺癌的女性常被建议不要再次怀孕。因此，我们进行了一项荟萃分析，以了解妊娠对曾患有乳腺癌女性的总生存的影响。
两位作者独立进行了文献检索，检索时间截至 2009 年 9 月，无语言限制。纳入的研究为发表的回顾性对照匹配、基于人群和基于医院的研究，这些研究探讨了妊娠对曾患有乳腺癌女性的总生存的影响。使用随机效应模型对数据进行合并。为进一步进行亚组和敏感性分析，从三项研究中获取了未发表的统计数据。这包括根据诊断时的年龄、健康母亲效应、研究类型、淋巴结状态和其他参数，来检查妊娠的影响。
共有 14 项研究纳入本荟萃分析（1244 例病例和 18145 例对照）。与未妊娠的女性相比，在乳腺癌诊断后怀孕的女性死亡风险降低了 41% [PRR：0.59（90%置信区间（CI）：0.50-0.70）]。这种差异与研究类型无关，尤其是在淋巴结阴性疾病史的女性中更为明显。在亚组分析中，我们比较了曾患有乳腺癌并已怀孕的女性与未怀孕且已知无复发的乳腺癌患者的结局。在该分析中，我们未发现两组之间的生存存在显著差异 [PRR：0.85；95%CI：0.53-1.35]。
本研究证实，曾患有乳腺癌的女性妊娠是安全的，且不会影响其总生存。因此，不应剥夺乳腺癌幸存者再次怀孕的机会。
