Epidemiology

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Incidence and outcomes of pregnancy-associated cancer in Australia, 1994–2008: a population-based linkage study

  1. YY Lee1,
  2. CL Roberts1,
  3. T Dobbins2,
  4. E Stavrou3,
  5. K Black4,
  6. J Morris1,
  7. J Young2

Article first published online: 5 SEP 2012

DOI: 10.1111/j.1471-0528.2012.03475.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 119, Issue 13, pages 1572–1582, December 2012

Additional Information

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

Author Information

  1. 1

     Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW

  2. 2

     Cancer Epidemiology and Services Research Group, Sydney School of Public Health, University of Sydney, Sydney, NSW

  3. 3

     Adult Cancer Program, Lowy Cancer Research Centre, University of New South Wales, Sydney, NSW

  4. 4

     Department of Obstetrics and Gynaecology, University of Sydney, Sydney, NSW, Australia

*Prof CL Roberts, University Department of Obstetrics and Gynaecology, Building B52, Royal North Shore Hospital, St Leonards, NSW 2065, Australia. Email clroberts@med.usyd.edu.au

  1. Re-use of this article is permitted in accordance with the Terms and Conditions set out at http://wileyonlinelibrary.com/onlineopen#OnlineOpen_Terms

Publication History

  1. Issue published online: 12 NOV 2012
  2. Article first published online: 5 SEP 2012
  3. Accepted 10 July 2012. Published Online 5 September 2012.

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Keywords:

  • Cancer;
  • cohort study;
  • incidence;
  • pregnancy;
  • 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.

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