Simonella Leonardo, Verkooijen Helena M, Edgren Gustaf, Liu Jenny, Hui Miao, Salim Agus, Czene Kamila, Hartman Mikael
Saw Swee Hock School of Public Health, National University of Singapore, 16 Medical Drive, Singapore, 117597, Singapore,
Breast Cancer Res Treat. 2014 Jul;146(2):393-9. doi: 10.1007/s10549-014-3013-8. Epub 2014 Jun 17.
To assess whether children born to primiparous women around the time of a breast cancer diagnosis have an increased mortality risk. From the merged Swedish Multi-Generation and Cancer Registers, we identified 49,750 eligible children whose mother was diagnosed with breast cancer between 1958 and 2010. Mortality rates in offspring were compared to the background population using standardized mortality ratios (SMR), adjusted for calendar year of birth, attained age, and sex, and calculated for each category of timing of delivery (before, around, or after mother's diagnosis) and mother's parity status. Hazard ratios were assessed using a Cox proportional hazards model and adjusted for socioeconomic status, year of birth and mother's age at birth. Children born to a primiparous woman around a breast cancer diagnosis had a mortality rate five times greater than the background population (SMR 5.26, 95 % CI 1.93-11.5), whereas children born to a multiparous woman had a twofold increase (SMR 2.40, 95 % CI 1.10-4.55). Children of primiparous women born around diagnosis had an adjusted hazard ratio fourfold to that of children of primiparous women born before their mother's diagnosis (HR 4.29, 95 % CI 1.68-8.91), whereas hazard ratios for children of primiparous or multiparous women born at other times were not statistically significant. Children born to primiparous women around a breast cancer diagnosis have an increased relative mortality risk. Although relative risk is increased, in absolute terms children born from a cancer complicated pregnancy do relatively well. Additional investigations are needed to elucidate the reason(s) underlying this observation before the information can be used to inform patient counseling and clinical care.
评估初产妇在乳腺癌诊断前后所生孩子的死亡风险是否增加。通过合并瑞典多代人和癌症登记册，我们确定了49750名符合条件的儿童，其母亲在1958年至2010年间被诊断出患有乳腺癌。使用标准化死亡率（SMR）将后代的死亡率与背景人群进行比较，并根据出生年份、达到的年龄和性别进行调整，针对每种分娩时间类别（母亲诊断之前、期间或之后）和母亲的生育状况进行计算。使用Cox比例风险模型评估风险比，并根据社会经济地位、出生年份和母亲的生育年龄进行调整。乳腺癌诊断前后初产妇所生孩子的死亡率比背景人群高五倍（SMR 5.26，95%置信区间1.93-11.5），而经产妇所生孩子的死亡率增加了两倍（SMR 2.40，95%置信区间1.10-4.55）。诊断前后初产妇所生孩子的调整后风险比是母亲诊断前初产妇所生孩子的四倍（HR 4.29，95%置信区间1.68-8.91），而其他时间初产妇或经产妇所生孩子的风险比无统计学意义。乳腺癌诊断前后初产妇所生孩子的相对死亡风险增加。尽管相对风险增加，但从绝对数量来看，癌症合并妊娠所生孩子的情况相对较好。在该信息可用于指导患者咨询和临床护理之前，需要进行更多调查以阐明这一观察结果背后的原因。
