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Incidence and outcomes of pregnancy-associated cancer in Australia, 1994–2008: a population-based linkage study
Article first published online: 5 SEP 2012
© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 119, Issue 13, pages 1572–1582, December 2012
How to Cite
Lee, Y., Roberts, C., Dobbins, T., Stavrou, E., Black, K., Morris, J. and Young, J. (2012), Incidence and outcomes of pregnancy-associated cancer in Australia, 1994–2008: a population-based linkage study. BJOG: An International Journal of Obstetrics & Gynaecology, 119: 1572–1582. doi: 10.1111/j.1471-0528.2012.03475.x
- Issue published online: 12 NOV 2012
- Article first published online: 5 SEP 2012
- Accepted 10 July 2012. Published Online 5 September 2012.
- cohort study;
- record linkage
Please cite this paper as: Lee Y, Roberts C, Dobbins T, Stavrou E, Black K, Morris J, Young J. Incidence and outcomes of pregnancy-associated cancer in Australia, 1994–2008: a population-based linkage study. BJOG 2012;119:1572–1582.
Objective To determine trends in pregnancy-associated cancer and associations between maternal cancer and pregnancy outcomes.
Design Population-based cohort study.
Setting New South Wales, Australia, 1994–2008.
Population A total of 781 907 women and their 1 309 501 maternities.
Methods Cancer and maternal information were obtained from linked cancer registry, birth and hospital records for the entire population. Generalised estimating equations with a logit link were used to examine associations between cancer risk factors and pregnancy outcomes.
Main outcome measures Incidence of pregnancy-associated cancer (diagnosis during pregnancy or within 12 months of delivery), maternal morbidities, preterm birth, and small- and large-for-gestational-age (LGA).
Results A total of 1798 new cancer diagnoses were identified, including 499 during pregnancy and 1299 postpartum. From 1994 to 2007, the crude incidence rate of pregnancy-associated cancer increased from 112.3 to 191.5 per 100 000 maternities (P < 0.001), and only 14% of the increase was explained by increasing maternal age. Cancer diagnosis was more common than expected in women aged 15–44 years (observed-to-expected ratio 1.49; 95% CI 1.42–1.56). Cancers were predominantly melanoma (33.3%) and breast cancer (21.0%). Women with cancer diagnosed during pregnancy had high rates of labour induction (28.5%), caesarean section (40.0%) and planned preterm birth (19.7%). Novel findings included a cancer association with multiple pregnancies (adjusted odds ratio 1.52, 95% CI 1.13–2.05) and LGA (aOR 1.47, 95% CI 1.14–1.89).
Conclusions Pregnancy-associated cancers have increased, and this increase is only partially explained by increasing maternal age. Pregnancy increases women’s interaction with health services and the possibility for diagnosis, but may also influence tumour growth.