1
|
Lundberg FE, Stensheim H, Ullenhag GJ, Sahlgren H, Lindemann K, Fredriksson I, Johansson ALV. Risk factors for the increasing incidence of pregnancy-associated cancer in Sweden - a population-based study. Acta Obstet Gynecol Scand 2024; 103:669-683. [PMID: 37694965 PMCID: PMC10993331 DOI: 10.1111/aogs.14677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION The incidence of cancer during pregnancy and within first year post-delivery, ie pregnancy-associated cancer (PAC), is increasing in many countries, but little is known about risk factors for these trends. This study quantified incidence of PAC by trimesters and post-delivery periods, and assessed the role of maternal age, parity, immigrant status, education, smoking and body mass index for the risk and incidence trends of PAC. MATERIAL AND METHODS We used data from the national birth and cancer registers in Sweden during 1973-2017 to define a register-based cohort of women aged 15-44 years. Incidence rates of PAC during pregnancy and up to 1 year post-delivery were calculated per 100 000 deliveries per year. Poisson regression with multiple imputation estimated incidence rate ratios with 95% confidence intervals adjusted by year, age, previous parity, immigrant status, education, smoking and BMI during 1990-2017, when information on risk factors was available. RESULTS Among 4 557 284 deliveries, a total of 1274 (during pregnancy) and 3355 (within 1 year post-delivery) cases of PAC were diagnosed, with around 50 cases/year diagnosed during pregnancy and 110 cases/year during the first year post-delivery in the latest period 2015-2017. The most common cancer types during pregnancy were malignant melanoma, breast and cervical cancer, together accounting for 57% of cases during pregnancy and 53% during the first year post-delivery. The numbers of PAC were lower during pregnancy than during post-delivery for all tumor types with lowest numbers during first trimester. The PAC incidence rates increased over calendar time. High maternal age at diagnosis, smoking, nulliparity and non-immigrant background were associated with significantly higher risks of PAC. The increasing PAC incidence was in part explained by higher maternal age over time, but not by the other factors. CONCLUSIONS High maternal age is the strongest risk factor for PAC. We show for the first time that smoking, nulliparity and non-immigrant background are also contributing risk factors for PAC. However, only high maternal age contributed significantly to the increasing incidence. Further studies on other potential risk factors for PAC are warranted, since our results indicate that age on its own does not fully explain the increase.
Collapse
Affiliation(s)
- Frida E. Lundberg
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of Pathology‐OncologyKarolinska InstitutetStockholmSweden
| | | | - Gustav J. Ullenhag
- Department of OncologyUppsala University HospitalUppsalaSweden
- Department of Immunology, Genetics and PathologyUppsala UniversityUppsalaSweden
| | - Hanna Milerad Sahlgren
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of Obstetrics and GynecologyFalun HospitalFalunSweden
- Regional Cancer Center UppsalaUppsalaSweden
| | - Kristina Lindemann
- Department of Gynecological OncologyOslo University HospitalOsloNorway
- Faculty of Medicine, Institute of Clinical MedicineUniversity of OsloNorway
| | - Irma Fredriksson
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Breast, Endocrine Tumors and SarcomaKarolinska University HospitalStockholmSweden
| | - Anna L. V. Johansson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Cancer Registry of NorwayOsloNorway
| |
Collapse
|
2
|
Milosevic B, Likic Ladjevic I, Dotlic J, Beleslin A, Mihaljevic O, Pilic I, Kesic V, Gojnic M, Stefanovic A, Stefanovic K. Cancer during pregnancy: Twenty-two years of experience from a tertiary referral center. Acta Obstet Gynecol Scand 2024; 103:716-728. [PMID: 38216215 PMCID: PMC10993340 DOI: 10.1111/aogs.14756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Cancer complicating pregnancy is a rare but potentially life-threatening condition for both the mother and her child. The aim of the present study was to assess the outcomes for mothers and children after pregnancy complicated by malignancy and to investigate which parameters are important for their 1-year survival. MATERIAL AND METHODS The study included 84 pregnant women diagnosed with malignant tumors during pregnancy from 2001 to 2022. The pregnancy course and outcome, as well as parameters that could influence the survival and condition of the mother and child were evaluated. Mothers and children were followed up for 1 year after delivery to assess their condition/complications and overall survival. RESULTS Most malignancies were gynecological (31%) or hematological (23.8%) and were diagnosed and surgically treated in the second trimester. Most children (69%) showed adequate growth and development throughout pregnancy but were delivered before term (53.6%) to allow mothers to receive therapy. Adjuvant therapy during pregnancy mostly caused a transitory deterioration of the child's condition, while surgery did not significantly impact the pregnancy course. Deliveries, on average, occurred during the 33.01 ± 6.16 gestational week (range: 20-40) and mostly by cesarean section (76.2%). For mothers, the pregnancy survival rate was 95.2% and survival after 1 year was 87.5%. However, 37.5% of women were still ill and required additional therapy 1 year postpartum. The pregnancy survival rate for children was 94%, whereas the 1-year survival rate was 76.2%. Most children had a favorable condition (alive, adequately growing and developing, and without complications) at birth (81%) as well as at the 1-year follow-up (63.7%). Regression analysis identified the following predictors of favorable 1-year maternal condition: applying therapy during pregnancy, no progression of the malignancy during pregnancy, and delivery at a later gestational week. Predictors of favorable 1-year condition of children were lower histopathological grade of malignancy, surgery as therapy for malignancy, obtaining higher birthweight, and delivery by cesarean section. CONCLUSIONS If the malignancy is not progressing, pregnancy should be continued as long as possible for the child to obtain adequate birthweight. Both surgery and chemotherapy were safe therapeutic choices, as most pregnancies continued successfully after therapy.
Collapse
Affiliation(s)
- Branislav Milosevic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Ivana Likic Ladjevic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Jelena Dotlic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Aleksandra Beleslin
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Olga Mihaljevic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Igor Pilic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Vesna Kesic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Miroslava Gojnic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Aleksandar Stefanovic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Katarina Stefanovic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| |
Collapse
|
3
|
Acharya B, Behera A, Behera S, Moharana S. Recent Advances in Nanotechnology-Based Drug Delivery Systems for the Diagnosis and Treatment of Reproductive Disorders. ACS APPLIED BIO MATERIALS 2024; 7:1336-1361. [PMID: 38412066 DOI: 10.1021/acsabm.3c01064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Over the past decade, nanotechnology has seen extensive integration into biomedical applications, playing a crucial role in biodetection, drug delivery, and diagnostic imaging. This is especially important in reproductive health care, which has become an emerging and significant area of research. Global concerns have intensified around disorders such as infertility, endometriosis, ectopic pregnancy, erectile dysfunction, benign prostate hyperplasia, sexually transmitted infections, and reproductive cancers. Nanotechnology presents promising solutions to address these concerns by introducing innovative tools and techniques, facilitating early detection, targeted drug delivery, and improved imaging capabilities. Through the utilization of nanoscale materials and devices, researchers can craft treatments that are not only more precise but also more effective, significantly enhancing outcomes in reproductive healthcare. Looking forward, the future of nanotechnology in reproductive medicine holds immense potential for reshaping diagnostics, personalized therapies, and fertility preservation. The utilization of nanotechnology-driven drug delivery systems is anticipated to elevate treatment effectiveness, minimize side effects, and offer patients therapies that are not only more precise but also more efficient. This review aims to delve into the various types, properties, and preparation techniques of nanocarriers specifically designed for drug delivery in the context of reproductive disorders, shedding light on the current landscape and potential future directions in this dynamic field.
Collapse
Affiliation(s)
- Biswajeet Acharya
- School of Pharmacy and Life Sciences, Centurion University of Technology and Management, Bhubaneswar, Odisha 752050, India
| | - Amulyaratna Behera
- School of Pharmacy and Life Sciences, Centurion University of Technology and Management, Bhubaneswar, Odisha 752050, India
| | | | - Srikanta Moharana
- Department of Chemistry, School of Applied Sciences, Centurion University of Technology and Management, Bhubaneswar, Odisha 752050, India
| |
Collapse
|
4
|
Zhang Y, Yang Z, Wang C, Du L, Liu Y. Pregnancy-associated breast cancer (PABC) in young women: a matched case-control study. ALL LIFE 2023. [DOI: 10.1080/26895293.2023.2167867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Yanshou Zhang
- Department of Breast Center, the Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Zhifen Yang
- Department of Obstetrics, the Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Chunyang Wang
- Department of Obstetrics, the Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Lijia Du
- Department of Obstetrics, the Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Yingru Liu
- Department of Obstetrics, the Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| |
Collapse
|
5
|
Cairncross ZF, Nelson G, Metcalfe A. Risk of Death Due to Pregnancy-Associated Cancers-More Questions Than Answers-Reply. JAMA Oncol 2023; 9:1589. [PMID: 37733360 DOI: 10.1001/jamaoncol.2023.3651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Zoe F Cairncross
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - Gregg Nelson
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - Amy Metcalfe
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
6
|
Loibl S, Azim HA, Bachelot T, Berveiller P, Bosch A, Cardonick E, Denkert C, Halaska MJ, Hoeltzenbein M, Johansson ALV, Maggen C, Markert UR, Peccatori F, Poortmans P, Saloustros E, Saura C, Schmid P, Stamatakis E, van den Heuvel-Eibrink M, van Gerwen M, Vandecaveye V, Pentheroudakis G, Curigliano G, Amant F. ESMO Expert Consensus Statements on the management of breast cancer during pregnancy (PrBC). Ann Oncol 2023; 34:849-866. [PMID: 37572987 DOI: 10.1016/j.annonc.2023.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023] Open
Abstract
The management of breast cancer during pregnancy (PrBC) is a relatively rare indication and an area where no or little evidence is available since randomized controlled trials cannot be conducted. In general, advances related to breast cancer (BC) treatment outside pregnancy cannot always be translated to PrBC, because both the interests of the mother and of the unborn should be considered. Evidence remains limited and/or conflicting in some specific areas where the optimal approach remains controversial. In 2022, the European Society for Medical Oncology (ESMO) held a virtual consensus-building process on this topic to gain insights from a multidisciplinary group of experts and develop statements on controversial topics that cannot be adequately addressed in the current evidence-based ESMO Clinical Practice Guideline. The aim of this consensus-building process was to discuss controversial issues relating to the management of patients with PrBC. The virtual meeting included a multidisciplinary panel of 24 leading experts from 13 countries and was chaired by S. Loibl and F. Amant. All experts were allocated to one of four different working groups. Each working group covered a specific subject area with two chairs appointed: Planning, preparation and execution of the consensus process was conducted according to the ESMO standard operating procedures.
Collapse
Affiliation(s)
- S Loibl
- GBG c/o GBG Forschungs GmbH, Neu-Isenburg; Centre for Haematology and Oncology Bethanien, Frankfurt am Main, Frankfurt; Goethe University Frankfurt, Frankfurt am Main, Frankfurt, Germany.
| | - H A Azim
- Breast Cancer Center, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - T Bachelot
- Department of medical oncology, Centre Léon Bérard, Lyon, France
| | - P Berveiller
- Department of Gynecology and Obstetrics, Poissy-Saint Germain Hospital, Poissy; UMR 1198 - BREED, INRAE, Paris Saclay University, RHuMA, Montigny-Le-Bretonneux, France
| | - A Bosch
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund; Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - E Cardonick
- Cooper Medical School at Rowan University, Camden, USA
| | - C Denkert
- Philipps-University Marburg and Marburg University Hospital (UKGM), Marburg, Germany
| | - M J Halaska
- Department of Obstetrics and Gynaecology, Third Faculty of Medicine, Charles University in Prague and Universital Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - M Hoeltzenbein
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Berlin, Germany
| | - A L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Cancer Registry of Norway, Oslo, Norway
| | - C Maggen
- Department of Obstetrics and Prenatal Medicine, University Hospital Brussels, Brussels, Belgium
| | - U R Markert
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - F Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - P Poortmans
- Iridium Netwerk, Antwerp; University of Antwerp, Antwerp, Belgium
| | - E Saloustros
- Department of Oncology, University General Hospital of Larissa, Larissa, Greece
| | - C Saura
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - P Schmid
- Cancer Institute, Queen Mary University London, London, UK
| | - E Stamatakis
- Department of Anesthesiology, 'Alexandra' General Hospital, Athens, Greece
| | | | - M van Gerwen
- Gynecologic Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam; Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, University of Amsterdam; Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - V Vandecaveye
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - G Pentheroudakis
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Curigliano
- Division of Early Drug Development, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - F Amant
- Gynecologic Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam; Division Gynaecologic Oncology, UZ Leuven, Belgium
| |
Collapse
|
7
|
Bateni SB, Sutradhar R, Everett K, Wright FC, Hong NJL. The Association Between Pregnancy Timing and Cumulative Exposure on Survival in Melanoma. Ann Surg Oncol 2023; 30:6332-6338. [PMID: 37386307 DOI: 10.1245/s10434-023-13819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND As melanoma is common among young women, the impact of pregnancy on melanoma prognosis is of interest. OBJECTIVE The purpose of this study was to examine the association between pregnancy and survival in female melanoma patients of childbearing age. METHODS We performed a population-level, retrospective cohort study of women of childbearing age (18-45 years) diagnosed with melanoma from 2007 to 2017 using administrative data from Ontario, Canada. Patients were categorized according to pregnancy status (i.e. pregnancy before [conception from 60 to 13 months prior to melanoma], pregnancy-associated [conception 12 months prior to and after], and pregnancy after [conception 12 months after] melanoma). Cox models were used to examine melanoma-specific survival (MSS) and overall survival (OS) associated with pregnancy status. RESULTS Of 1312 women with melanoma, most did not experience pregnancy (84.1%), with 7.6% experiencing a pregnancy-associated melanoma and 8.2% experiencing a pregnancy after melanoma. Pregnancy before melanoma occurred in 18.1% of patients. Pregnancy before (hazard ratio [HR] 0.67, 95% confidence interval [CI] 0.35-1.28), associated (HR 1.15, 95% CI 0.45-2.97), and after melanoma (HR 0.39, 95% CI 0.13-1.11) was not associated with a difference in MSS compared with those who did not experience a pregnancy during these time periods. Pregnancy status was also not associated with a difference in OS (p > 0.05). Cumulative weeks pregnant were not associated with a difference in MSS (4-week HR 0.99, 95% CI 0.92-1.07) or OS (4-week HR 1.00, 95% CI 0.94-1.06). CONCLUSIONS In this population-level analysis of female melanoma patients of childbearing age, pregnancy was not associated with a difference in survival, suggesting that pregnancy is not associated with a worse melanoma prognosis.
Collapse
Affiliation(s)
- Sarah B Bateni
- Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
- Division of Surgical Oncology, Department of General Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rinku Sutradhar
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Frances C Wright
- Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Nicole J Look Hong
- Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
- Division of General Surgery, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
8
|
Favero D, Lapuchesky LS, Poggio F, Nardin S, Perachino M, Arecco L, Scavone G, Ottonello S, Latocca MM, Borea R, Puglisi S, Cosso M, Fozza A, Spinaci S, Lambertini M. Choosing the appropriate pharmacotherapy for breast cancer during pregnancy: what needs to be considered? Expert Opin Pharmacother 2023; 24:1975-1984. [PMID: 38179613 DOI: 10.1080/14656566.2023.2293167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Breast cancer is the most commonly diagnosed malignancy during pregnancy. Breast cancer during pregnancy is a challenging clinical condition requiring proper and timely multidisciplinary management. AREAS COVERED This review focuses on the management of breast cancer during pregnancy with a focus about the current state-of-the-art on the feasibility and safety of pharmacotherapy approaches in this setting. EXPERT OPINION Multidisciplinary care is key for a proper diagnostic-therapeutic management of breast cancer during pregnancy. Engaging patients and their caregivers in the decision-making process is essential and psychological support should be provided. The treatment of patients with breast cancer during pregnancy should follow the same recommendations as those for breast cancer in young women outside pregnancy but taking into account the gestational age at the time of treatment.Anthracycline-, cyclophosphamide-, and taxane-based regimens can be safely administered during the second and third trimesters with standard protocols, preferring weekly regimens whenever possible. Endocrine therapy, immune checkpoint inhibitors, and targeted agents are contraindicated throughout pregnancy, also due to the very limited data available to guide their administration in this setting. During treatment, careful fetal growth monitoring is mandatory, and even after delivery proper health monitoring for the children exposed in utero to chemotherapy should be continued.
Collapse
Affiliation(s)
- Diletta Favero
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Laura Sabina Lapuchesky
- Department of Medical Oncology, Instituto Alexander Fleming, University of Buenos Aires, Buenos Aires, Argentina
| | - Francesca Poggio
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Nardin
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Perachino
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Arecco
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Graziana Scavone
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Silvia Ottonello
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Maddalena Latocca
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Roberto Borea
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Silvia Puglisi
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maurizio Cosso
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Fozza
- Department of Radiotherapy, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefano Spinaci
- Division of Breast Surgery, Ospedale Villa Scassi, Genoa, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Romano A, Mastrangelo S, Attina G, Maurizi P, Ruggiero A. Pregnancy-associated Cancer and Chemotherapy during Pregnancy. BIOMEDICAL AND PHARMACOLOGY JOURNAL 2023; 16:705-714. [DOI: 10.13005/bpj/2652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
The diagnosis of pregnancy-associated cancer, although rare, is a condition of great human and social significance and difficult clinical management. A pregnancy-associated neoplasm is defined as a cancer diagnosis made during pregnancy or within 12 months after delivery/abortion. The most common cancers in pregnancy occur most frequently in women of reproductive age with an incidence overall like that observed in non-pregnant women of the same age. This incidence is likely to increase in view of both the expected increase in certain malignancies among young women (particularly breast cancer and melanoma) and the increasing frequency of pregnancies undertaken later in life (fourth and fifth decades of life) that is characterizing modern society. Chemotherapy is generally contraindicated before 12 weeks of pregnancy due to the increased risk of congenital anomalies while exposure in the second and third trimester of pregnancy to chemotherapy has been associated with more growth restriction and preterm delivery. Clinical decisions about the optimal management should consider maternal and fetal characteristics with the involvement of a multidisciplinary team.
Collapse
Affiliation(s)
- Alberto Romano
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Stefano Mastrangelo
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Giorgio Attina
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Palma Maurizi
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| |
Collapse
|
11
|
Cairncross ZF, Shack L, Nelson G, Friedenreich CM, Ray J, Fell DB, Lisonkova S, Bhatti P, Sikdar K, McMorris C, Metcalfe A. Long-term Mortality in Individuals Diagnosed With Cancer During Pregnancy or Postpartum. JAMA Oncol 2023; 9:791-799. [PMID: 37022714 PMCID: PMC10080404 DOI: 10.1001/jamaoncol.2023.0339] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/09/2023] [Indexed: 04/07/2023]
Abstract
Importance Outcomes among patients with pregnancy-associated cancers (diagnosed during pregnancy or 1-year postpartum) other than breast cancer have received relatively little research attention. High-quality data from additional cancer sites are needed to inform the care of this unique group of patients. Objective To assess mortality and survival in premenopausal women with pregnancy-associated cancers, with a particular focus on cancers other than those of the breast. Design, Setting, and Participants This population-based retrospective cohort study included premenopausal women (aged 18-50 years) living in 3 Canadian provinces (Alberta, British Columbia, and Ontario) diagnosed with cancer between January 1, 2003, and December 31, 2016, with follow-up until December 31, 2017, or date of death. Data analysis occurred in 2021 and 2022. Exposures Participants were categorized as being diagnosed with cancer during pregnancy (from conception to delivery), during the postpartum period (up to 1 year after delivery), or during a time that was remote from pregnancy. Main Outcomes and Measures Outcomes were overall survival at 1 and 5 years and time from diagnosis to death due to any cause. Cox proportional hazard models were used to estimate mortality adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs), adjusting for age at cancer diagnosis, cancer stage, cancer site, and days from diagnosis to first treatment. Meta-analysis was used to pool results across all 3 provinces. Results During the study period there were 1014, 3074, and 20 219 participants diagnosed with cancer during pregnancy, postpartum, and periods remote from pregnancy, respectively. One-year survival was similar across the 3 groups, but 5-year survival was lower among those diagnosed with cancer during pregnancy or postpartum. Overall, there was a greater risk of death due to pregnancy-associated cancer among those diagnosed during pregnancy (aHR, 1.79; 95% CI, 1.51-2.13) and postpartum (aHR, 1.49; 95% CI, 1.33-1.67); however, these results varied across cancer sites. Increased hazard of mortality was observed for breast (aHR, 2.01; 95% CI, 1.58-2.56), ovarian (aHR, 2.60; 95% CI, 1.12-6.03), and stomach (aHR, 10.37; 95% CI, 3.56-30.24) cancers diagnosed during pregnancy, and brain (aHR, 2.75; 95% CI, 1.28-5.90), breast (aHR, 1.61; 95% CI, 1.32-1.95), and melanoma (aHR, 1.84; 95% CI, 1.02-3.30) cancers diagnosed postpartum. Conclusions and Relevance This population-based cohort study found that pregnancy-associated cancers had increased overall 5-year mortality, though not all cancer sites presented the same risk.
Collapse
Affiliation(s)
- Zoe F. Cairncross
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - Lorraine Shack
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Oncology, University of Calgary, Calgary, Canada
- Cancer Research and Analytics, CancerControl Alberta, Alberta Health Services, Calgary, Canada
| | - Gregg Nelson
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - Christine M. Friedenreich
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Oncology, University of Calgary, Calgary, Canada
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Canada
| | - Joel Ray
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
- SickKids Research Institute, Toronto, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
| | - Deshayne B. Fell
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Sarka Lisonkova
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | | | - Khokan Sikdar
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Surveillance and Reporting, Alberta Health Services, Calgary, Canada
| | - Carly McMorris
- Werklund School of Education, University of Calgary, Calgary, Canada
| | - Amy Metcalfe
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
12
|
Nguyen T, Nougaret S, Castillo P, Paspulati R, Bhosale P. Cervical cancer in the pregnant population. Abdom Radiol (NY) 2023; 48:1679-1693. [PMID: 37071123 DOI: 10.1007/s00261-023-03836-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 04/19/2023]
Abstract
Cervical cancer is the second most encountered cancer in pregnant patients. The 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer updated the staging of primary cervical carcinoma and disease process, with formal incorporation of imaging as a vital source of information in the management process to improve accuracy. Diagnosis and treatment of the pregnant population is a complex interplay of achieving adequate diagnostic information and optimal treatment while minimizing toxicity and risks to the mother and fetus. While novel imaging techniques and anticancer therapies are rapidly developed, much information on the safety and feasibility of different therapies is not yet available in the pregnant population. Therefore, managing pregnant patients with cervical cancer is complex and requires a multidisciplinary approach.
Collapse
Affiliation(s)
- Trinh Nguyen
- Billings Clinic Hospital, 2800 10th Ave N, Billings, MT, 95106, USA.
| | - Stephanie Nougaret
- Institute Regional du Cancer Montpellier, EU Euromedicine Park, 208 Av. des Apothicaires, 34090, Montpellier, France
| | - Patricia Castillo
- Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | | | - Priya Bhosale
- MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| |
Collapse
|
13
|
Dixit N, Braaten KP, Taylor C, Nekhlyudov L. Reproductive choice is supportive care in cancer. Support Care Cancer 2023; 31:249. [PMID: 37017781 DOI: 10.1007/s00520-023-07715-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/28/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Niharika Dixit
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Kari P Braaten
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | | | | |
Collapse
|
14
|
Revzin MV, Solomon N, Langdon J, Czeyda-Pommersheim F, Menias CO. Delayed cancer diagnosis in the pregnant patient: navigating a complex medical and ethical dilemma. Abdom Radiol (NY) 2023; 48:1599-1604. [PMID: 36951988 DOI: 10.1007/s00261-023-03860-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/24/2023]
Abstract
Prompt diagnosis of cancer in pregnancy is necessary to ensure timely management and improve outcomes. However, there are a several reasons why diagnosis may be delayed in pregnancy. Three major contributors to delayed diagnosis and treatment are patient delay, provider delay, and referral delay. This article aims to (1) increase physician awareness of this problem by providing a detailed review of the main culprits of delayed diagnosis and treatment of cancer in the pregnant patient, (2) discuss the complex ethical issues at hand in these cases, and (3) provide suggestions on how to better address such cases with the goal of improving patient outcomes.
Collapse
Affiliation(s)
- Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA.
| | - Nadia Solomon
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA
| | - Jonathan Langdon
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA
| | - Ferenc Czeyda-Pommersheim
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA
| | - Christine O Menias
- Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| |
Collapse
|
15
|
Di Ciaccio PR, Mills G, Shipton MJ, Campbell B, Gregory G, Langfield J, Greenwood M, McKeague S, Shanavas M, Eslick R, Kidson-Gerber G, Smallbone P, Tang C, Morris K, Bilmon I, Yannakou C, Badoux X, Berkahn L, Farina S, Mason KD, Motum P, Goss K, Hamad N. The clinical features, management and outcomes of lymphoma in pregnancy: A multicentre study by the Australasian Lymphoma Alliance. Br J Haematol 2023; 201:887-896. [PMID: 36880558 DOI: 10.1111/bjh.18727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/18/2023] [Accepted: 02/18/2023] [Indexed: 03/08/2023]
Abstract
Lymphoma in pregnancy (LIP) presents unique clinical, social and ethical challenges; however, the evidence regarding this clinical scenario is limited. We conducted a multicentre retrospective observational study reporting on the features, management, and outcomes of LIP in patients diagnosed between January 2009 and December 2020 at 16 sites in Australia and New Zealand for the first time. We included diagnoses occurring either during pregnancy or within the first 12 months following delivery. A total of 73 patients were included, 41 diagnosed antenatally (AN cohort) and 32 postnatally (PN cohort). The most common diagnoses were Hodgkin lymphoma (HL; 40 patients), diffuse large B-cell lymphoma (DLBCL; 11) and primary mediastinal B-cell lymphoma (PMBCL; six). At a median follow up of 2.37 years, the 2- and 5-year overall survival (OS) for patients with HL were 91% and 82%. For the combined DLBCL and PMBCL group, the 2-year OS was 92%. Standard curative chemotherapy regimens were successfully delivered to 64% of women in the AN cohort; however, counselling regarding future fertility and termination of pregnancy were suboptimal, and a standardised approach to staging lacking. Neonatal outcomes were generally favourable. We present a large multicentre cohort of LIP reflecting contemporary practice and identify areas in need of ongoing research.
Collapse
Affiliation(s)
- Pietro R Di Ciaccio
- Sydney Adventist Hospital, Wahroonga, New South Wales, Australia.,College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia.,School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Georgia Mills
- Northern Beaches Hospital, Frenchs Forest, New South Wales, Australia.,Faculty of Medicine, Macquarie University, Ryde, New South Wales, Australia
| | - Michael J Shipton
- Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Belinda Campbell
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia
| | | | - Jenna Langfield
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Matthew Greenwood
- Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Sean McKeague
- Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - Mohammad Shanavas
- Mater Hospital Brisbane, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
| | - Renee Eslick
- The Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Giselle Kidson-Gerber
- Prince of Wales Hospital and The Royal Hospital for Women, Randwick, New South Wales, Australia.,Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia
| | | | - Catherine Tang
- Gosford Hospital, Gosford, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Kirk Morris
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Ian Bilmon
- Sydney Adventist Hospital, Wahroonga, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Westmead Hospital, Westmead, New South Wales, Australia
| | - Costas Yannakou
- Epworth Freemasons, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Xavier Badoux
- St George Hospital, Kogarah, New South Wales, Australia
| | | | | | - Kylie D Mason
- Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Penelope Motum
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | | | - Nada Hamad
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia.,Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia.,School of Medicine, Sydney, University of Notre, Sydney, New South Wales, Australia
| |
Collapse
|
16
|
Bertozzi S, Corradetti B, Seriau L, Diaz Ñañez JA, Cedolini C, Fruscalzo A, Cesselli D, Cagnacci A, Londero AP. Nanotechnologies in Obstetrics and Cancer during Pregnancy: A Narrative Review. J Pers Med 2022; 12:jpm12081324. [PMID: 36013273 PMCID: PMC9410527 DOI: 10.3390/jpm12081324] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/01/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022] Open
Abstract
Nanotechnology, the art of engineering structures on a molecular level, offers the opportunity to implement new strategies for the diagnosis and management of pregnancy-related disorders. This review aims to summarize the current state of nanotechnology in obstetrics and cancer in pregnancy, focusing on existing and potential applications, and provides insights on safety and future directions. A systematic and comprehensive literature assessment was performed, querying the following databases: PubMed/Medline, Scopus, and Endbase. The databases were searched from their inception to 22 March 2022. Five independent reviewers screened the items and extracted those which were more pertinent within the scope of this review. Although nanotechnology has been on the bench for many years, most of the studies in obstetrics are preclinical. Ongoing research spans from the development of diagnostic tools, including optimized strategies to selectively confine contrast agents in the maternal bloodstream and approaches to improve diagnostics tests to be used in obstetrics, to the synthesis of innovative delivery nanosystems for therapeutic interventions. Using nanotechnology to achieve spatial and temporal control over the delivery of therapeutic agents (e.g., commonly used drugs, more recently defined formulations, or gene therapy-based approaches) offers significant advantages, including the possibility to target specific cells/tissues of interest (e.g., the maternal bloodstream, uterus wall, or fetal compartment). This characteristic of nanotechnology-driven therapy reduces side effects and the amount of therapeutic agent used. However, nanotoxicology appears to be a significant obstacle to adopting these technologies in clinical therapeutic praxis. Further research is needed in order to improve these techniques, as they have tremendous potential to improve the accuracy of the tests applied in clinical praxis. This review showed the increasing interest in nanotechnology applications in obstetrics disorders and pregnancy-related pathologies to improve the diagnostic algorithms, monitor pregnancy-related diseases, and implement new treatment strategies.
Collapse
Affiliation(s)
- Serena Bertozzi
- Breast Unit, Department of Surgery, DAME, University Hospital of “Santa Maria della Misericordia”, 33100 Udine, Italy
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, Italy
| | - Bruna Corradetti
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX 77030, USA
| | - Luca Seriau
- Breast Unit, Department of Surgery, DAME, University Hospital of “Santa Maria della Misericordia”, 33100 Udine, Italy
| | - José Andrés Diaz Ñañez
- Breast Unit, Department of Surgery, DAME, University Hospital of “Santa Maria della Misericordia”, 33100 Udine, Italy
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, Italy
| | - Carla Cedolini
- Breast Unit, Department of Surgery, DAME, University Hospital of “Santa Maria della Misericordia”, 33100 Udine, Italy
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, Italy
| | - Arrigo Fruscalzo
- Clinic of Obstetrics and Gynecology, University Hospital of Fribourg, 1752 Fribourg, Switzerland
| | - Daniela Cesselli
- Institute of Pathology, DAME, University of Udine, University Hospital of Udine, 33100 Udine, Italy
| | - Angelo Cagnacci
- Academic Unit of Obstetrics and Gynaecology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, Italy
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Ambrogio P. Londero
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, Italy
- Academic Unit of Obstetrics and Gynaecology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, Italy
- Correspondence: or
| |
Collapse
|
17
|
Cancer in pregnancy: overview and epidemiology. Abdom Radiol (NY) 2022; 48:1559-1563. [PMID: 35960309 DOI: 10.1007/s00261-022-03633-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/01/2022]
Abstract
Cancer in pregnancy, one of the most distressing and demanding conditions in all of women's health care, occurs about 1:1000 pregnancies with an increasing incidence due to delayed childbearing. Diagnosis of pregnancy associated cancer is especially challenging because tumor symptoms may be masked by normal physiologic changes of pregnancy. The burden of care for both mother and child goes well beyond factual medical information. Balancing the potential risks and benefits to the mother and fetus necessitates a superior level of knowledge and expertise that includes epidemiology, pathophysiology, ionizing radiation and teratogenesis, risks and benefits of various imaging modalities, oncology, and radiotherapy, and other areas. Radiologists are an integral part of a multidisciplinary team that shares responsibility for selection of safe and effective diagnosis and management. Throughout the course of treatment, counseling and support are of paramount importance to the patient and her family. A compassionate culture of care bolsters the effectiveness of the care team to inform, counsel, and engage with the patient to achieve optimal outcomes. This special section of Abdominal Radiology is meant to offer insights for diagnostic imaging and its role in personalized management of this most serious and challenging condition. This article will provide an overview of imaging cancer in pregnancy and detail the relevant epidemiology.
Collapse
|
18
|
Johansson ALV, Dickman PW, Eloranta S, Björkholm M. Reproductive history, as measured by parity, age at first birth and sex of offspring, and cancer-specific survival after a haematological malignancy. Acta Oncol 2022; 61:764-772. [PMID: 35451928 DOI: 10.1080/0284186x.2022.2064726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Overall, women have better cancer-specific survival than men following haematological malignancies. The effect of reproductive factors on prognosis in women remains unknown and population-based studies are needed. MATERIAL AND METHODS A nationwide cohort of 21,237 Swedish women with a recorded haematological malignancy at ages 18-69 years was identified in the Swedish Cancer Register 1970-2018. Pre-diagnosis childbirths for each woman were linked to the Swedish Multigeneration Register. Net survival and excess hazard ratios for parity, age at first birth, time since the latest birth, and sex of offspring were estimated using flexible parametric models adjusted for age, year, and educational level. RESULTS In unadjusted analyses, parity (p = 0.0012) and high age at first birth (p < 0.0001) were associated with better survival. After co-adjustments for reproductive factors and confounders, the associations were attenuated. The adjusted association with parity was mainly observed among women aged above 40 years at diagnosis (p = 0.0033). The associations with reproductive factors were non-significant across subtypes of haematological malignancy. There was a tendency of higher excess mortality for an increasing number of boys compared to girls, although only significant for women with three or more children (p = 0.0126). CONCLUSION Reproductive factors were in part associated with survival following diagnosis of a haematological malignancy. However, the effect sizes were small with inconsistent association patterns, and thus reproductive factors may only partly contribute to the survival advantage of women over men.
Collapse
Affiliation(s)
- Anna L. V. Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Cancer Registry of Norway, Oslo, Norway
| | - Paul W. Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Eloranta
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Björkholm
- Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
19
|
Dumas E, Laot L, Coussy F, Grandal Rejo B, Daoud E, Laas E, Kassara A, Majdling A, Kabirian R, Jochum F, Gougis P, Michel S, Houzard S, Le Bihan-Benjamin C, Bousquet PJ, Hotton J, Azencott CA, Reyal F, Hamy AS. The French Early Breast Cancer Cohort (FRESH): A Resource for Breast Cancer Research and Evaluations of Oncology Practices Based on the French National Healthcare System Database (SNDS). Cancers (Basel) 2022; 14:cancers14112671. [PMID: 35681651 PMCID: PMC9179405 DOI: 10.3390/cancers14112671] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/10/2022] [Accepted: 05/22/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Because of an important disparity of care pathways and quality of care among women diagnosed with an early-stage breast cancer, we aimed to create a unique cohort of patients including all French women aged 18 years or over, treated by surgery and registered in the general health insurance coverage plan. After aggregating and annotating medico-administrative data on 235,368 early breast cancer patients, we open up perspectives for research on adverse effects, morbidity, mortality, the monitoring of care consumption, or medical-economic studies. We describe data sources, inclusion, and exclusion criteria, basic descriptive analyses, and longitudinal trends over time. Abstract Background: Breast cancer (BC) is the most frequent cancer and the leading cause of cancer-related death in women. The French National Cancer Institute has created a national cancer cohort to promote cancer research and improve our understanding of cancer using the National Health Data System (SNDS) and amalgamating all cancer sites. So far, no detailed separate data are available for early BC. Objectives: To describe the creation of the French Early Breast Cancer Cohort (FRESH). Methods: All French women aged 18 years or over, with early-stage BC newly diagnosed between 1 January 2011 and 31 December 2017, treated by surgery, and registered in the general health insurance coverage plan were included in the cohort. Patients with suspected locoregional or distant metastases at diagnosis were excluded. BC treatments (surgery, chemotherapy, targeted therapy, radiotherapy, and endocrine therapy), and diagnostic procedures (biopsy, cytology, and imaging) were extracted from hospital discharge reports, outpatient care notes, or pharmacy drug delivery data. The BC subtype was inferred from the treatments received. Results: We included 235,368 patients with early BC in the cohort (median age: 60 years). The BC subtype distribution was as follows: luminal (80.2%), triple-negative (TNBC, 9.5%); HER2+ (10.3%), or unidentifiable (n = 44,388, 18.9% of the cohort). Most patients underwent radiotherapy (n = 200,685, 85.3%) and endocrine therapy (n = 165,655, 70.4%), and 38.3% (n = 90,252) received chemotherapy. Treatments and care pathways are described. Conclusions: The FRESH Cohort is an unprecedented population-based resource facilitating future large-scale real-life studies aiming to improve care pathways and quality of care for BC patients.
Collapse
Affiliation(s)
- Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, 75005 Paris, France; (E.D.); (B.G.R.); (E.D.); (A.K.); (F.J.); (P.G.); (F.R.)
- INSERM, U900, 75005 Paris, France;
- MINES ParisTech, CBIO-Centre for Computational Biology, PSL Research University, 75006 Paris, France
| | - Lucie Laot
- Department of Surgical Oncology, Institut Curie, University of Paris, 75005 Paris, France; (L.L.); (E.L.); (S.M.)
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, University of Paris, 75005 Paris, France;
| | - Beatriz Grandal Rejo
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, 75005 Paris, France; (E.D.); (B.G.R.); (E.D.); (A.K.); (F.J.); (P.G.); (F.R.)
| | - Eric Daoud
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, 75005 Paris, France; (E.D.); (B.G.R.); (E.D.); (A.K.); (F.J.); (P.G.); (F.R.)
- INRIA, DI/ENS, PSL Research University, 75006 Paris, France
| | - Enora Laas
- Department of Surgical Oncology, Institut Curie, University of Paris, 75005 Paris, France; (L.L.); (E.L.); (S.M.)
| | - Amyn Kassara
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, 75005 Paris, France; (E.D.); (B.G.R.); (E.D.); (A.K.); (F.J.); (P.G.); (F.R.)
| | - Alena Majdling
- Centre René Hughenin, Medical Oncology Department, 92210 Saint Cloud, France; (A.M.); (R.K.)
| | - Rayan Kabirian
- Centre René Hughenin, Medical Oncology Department, 92210 Saint Cloud, France; (A.M.); (R.K.)
| | - Floriane Jochum
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, 75005 Paris, France; (E.D.); (B.G.R.); (E.D.); (A.K.); (F.J.); (P.G.); (F.R.)
- Department of Gynecology, Strasbourg University Hospital, 67091 Strasbourg, France
| | - Paul Gougis
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, 75005 Paris, France; (E.D.); (B.G.R.); (E.D.); (A.K.); (F.J.); (P.G.); (F.R.)
| | - Sophie Michel
- Department of Surgical Oncology, Institut Curie, University of Paris, 75005 Paris, France; (L.L.); (E.L.); (S.M.)
| | - Sophie Houzard
- Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 92100 Boulogne-Billancourt, France; (S.H.); (C.L.B.-B.); (P.-J.B.)
| | - Christine Le Bihan-Benjamin
- Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 92100 Boulogne-Billancourt, France; (S.H.); (C.L.B.-B.); (P.-J.B.)
| | - Philippe-Jean Bousquet
- Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 92100 Boulogne-Billancourt, France; (S.H.); (C.L.B.-B.); (P.-J.B.)
- Inserm, IRD, SESSTIM, Equipe Labellisée Ligue Contre le Cancer, Aix-Marseille Université, 13005 Marseille, France
| | - Judicaël Hotton
- Department of Surgery, Institut Jean Godinot, 51100 Reims, France;
| | - Chloé-Agathe Azencott
- INSERM, U900, 75005 Paris, France;
- MINES ParisTech, CBIO-Centre for Computational Biology, PSL Research University, 75006 Paris, France
- Institut Curie, PSL Research University, 75005 Paris, France
| | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, 75005 Paris, France; (E.D.); (B.G.R.); (E.D.); (A.K.); (F.J.); (P.G.); (F.R.)
- Department of Surgical Oncology, Institut Curie, University of Paris, 75005 Paris, France; (L.L.); (E.L.); (S.M.)
- Department of Surgery, Institut Jean Godinot, 51100 Reims, France;
| | - Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, 75005 Paris, France; (E.D.); (B.G.R.); (E.D.); (A.K.); (F.J.); (P.G.); (F.R.)
- Centre René Hughenin, Medical Oncology Department, 92210 Saint Cloud, France; (A.M.); (R.K.)
- Correspondence:
| |
Collapse
|
20
|
Bakhuis CFJ, Suelmann BBM, van Dooijeweert C, Linn S, van der Wall E, van Diest PJ. Receptor status of breast cancer diagnosed during pregnancy: A literature review. Crit Rev Oncol Hematol 2021; 168:103494. [PMID: 34715316 DOI: 10.1016/j.critrevonc.2021.103494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022] Open
Abstract
The definition of PABC is inconsistently given as either breast cancer diagnosed exclusively during pregnancy, or combined with breast cancer diagnosed within six months to five years after delivery, and sometimes even longer. The longer away from the delivery date breast cancer is diagnosed, the less clear this association with pregnancy may become. Therefore, breast cancer diagnosed during pregnancy (BCdP) may not necessarily be the same disease entity as PABC. This review aims to provide an overview of BCdP receptor status, as this has not been assessed before. BCdP tumors were predominantly ER negative (56.6 %), PR negative (57.2 %) or both ER and PR negative (47.9 %). Moreover, HER2-overexpression was seen in 33.2 % of BCdP patients and 27.6 % had triple negative disease. This predominantly ER and PR negative profile with more often HER2 overexpression is aggressive and distinct from non-pregnant similar-aged patients, warranting future comparative research.
Collapse
Affiliation(s)
- Carsten F J Bakhuis
- Department of Medical Oncology, University Medical Center Utrecht, the Netherlands
| | - Britt B M Suelmann
- Department of Medical Oncology, University Medical Center Utrecht, the Netherlands.
| | | | - Sabine Linn
- Department of Medical Oncology, Netherlands Cancer Institute (AVL-NKI), the Netherlands
| | - Elsken van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, the Netherlands
| |
Collapse
|