› Forums › General Melanoma Community › Recent Childbirth Is an Adverse Prognostic Factor ….in melanoma
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JC.
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- August 25, 2013 at 12:10 am
Research August 22, 2013Recent Childbirth Is an Adverse Prognostic Factor in Breast Cancer and Melanoma, but Not in Hodgkin Lymphoma
Eur. J. Cancer 2013 Aug 06;[EPub Ahead of Print], H Moller, A Purushotham, KM Linklater, H Garmo, L Holmberg, M Lambe, D Yallop, S Devereux
Research August 22, 2013Recent Childbirth Is an Adverse Prognostic Factor in Breast Cancer and Melanoma, but Not in Hodgkin Lymphoma
Eur. J. Cancer 2013 Aug 06;[EPub Ahead of Print], H Moller, A Purushotham, KM Linklater, H Garmo, L Holmberg, M Lambe, D Yallop, S Devereux
TAKE-HOME MESSAGE
Prognosis is poor in women with a pregnancy-associated breast cancer or melanoma (pregnancy-associated cancer defined in this study as childbirth within 1 to 5 years prior to the cancer diagnosis). The authors suggest cause independent of tumor stage, possibly a biological mechanism, is at play.
ABSTRACT
Background: The relationship between gestation, childbirth and cancer prognosis is unknown for most cancers (e.g. Hodgkin lymphoma), whereas a body of evidence exists for melanoma and breast cancer.
Methods: The national cancer registration and hospital discharge data for women in England (1998-2007) were linked, and the records for Hodgkin lymphoma, melanoma and breast cancer were indexed as to whether women had delivered a child in separate time periods prior to their cancer diagnosis. Survival analyses were conducted in order to characterise prognosis in relation to childbirth, with statistical adjustment for age and (where possible) stage.
Findings: For melanoma and breast cancer, survival was strongly reduced in women who gave birth in the year prior to cancer diagnosis. The age-adjusted hazard ratios (HR) with 95% confidence intervals (CI) were 2.06 (1.42-3.01) for melanoma and 1.84 (1.64-2.06) for breast cancer. The associations were only slightly attenuated by further adjustment for tumour stage. For breast cancer, the excess death rate in women with a recent childbirth peaked at 2years and remained elevated for 6 to 8years. Previous childbirth had no overall effect on the outcome of Hodgkin lymphoma.
Interpretation: Melanoma and breast cancer prognosis are adversely affected by recent gestation and childbirth in a way that is not due to stage of the cancer, but rather to inherent biological properties of the tumours. Possible biological mechanisms include immunosuppression (melanoma), the hormonal milieu in gestation and a tumour promoting microenvironment post-partum (breast cancer).
European Journal of CancerRecent Childbirth Is an Adverse Prognostic Factor in Breast Cancer and Melanoma, but Not in Hodgkin Lymphoma
Eur. J. Cancer 2013 Aug 06;[EPub Ahead of Print], H Moller, A Purushotham, KM Linklater, H Garmo, L Holmberg, M Lambe, D Yallop, S Devereux
The publisher has made this article available for free until 9/5/2013 12:00:00 AM .
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- August 25, 2013 at 1:35 pm
Since posting this, I have been questioning it. There are no case numbers mentioned in the abstract, so is it many or few? Might make a difference. The article is said to be free, which it is not….apparently a misprint when posting the abstract.
And if childbirth is accompanied by immunosuppression, it would not be surprising since a pregnant woman would not want to have a rejection situation in the baby because it is partly non-self. Like organ transplants have rejection and their patients have to go on immune suppressing drugs. But it would seem like if this is true, it should apply to all cancers, not just these two. And why would the hormone environment and immune suppression go on for five years or more, in the absence of multiple children?
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- August 25, 2013 at 1:35 pm
Since posting this, I have been questioning it. There are no case numbers mentioned in the abstract, so is it many or few? Might make a difference. The article is said to be free, which it is not….apparently a misprint when posting the abstract.
And if childbirth is accompanied by immunosuppression, it would not be surprising since a pregnant woman would not want to have a rejection situation in the baby because it is partly non-self. Like organ transplants have rejection and their patients have to go on immune suppressing drugs. But it would seem like if this is true, it should apply to all cancers, not just these two. And why would the hormone environment and immune suppression go on for five years or more, in the absence of multiple children?
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- August 25, 2013 at 1:35 pm
Since posting this, I have been questioning it. There are no case numbers mentioned in the abstract, so is it many or few? Might make a difference. The article is said to be free, which it is not….apparently a misprint when posting the abstract.
And if childbirth is accompanied by immunosuppression, it would not be surprising since a pregnant woman would not want to have a rejection situation in the baby because it is partly non-self. Like organ transplants have rejection and their patients have to go on immune suppressing drugs. But it would seem like if this is true, it should apply to all cancers, not just these two. And why would the hormone environment and immune suppression go on for five years or more, in the absence of multiple children?
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- August 25, 2013 at 6:01 pm
The full text of this article is available at no cost here: http://www.sciencedirect.com/science/article/pii/S0959804913005583 I don't know how long it will be available for free.
The statistical methods here are pretty heavy-duty and I'm not sure I am reading them correctly. But my understanding is that of approximately 16,000 female melanoma patients diagnosed in the years from 1998–2008, 306 were diagnosed with melanoma within a year after childbirth. This is approximately twice as many melanoma diagnoses than for women who developed melanoma more than one year after giving birth.
The authors conclude that for women who DO NOT HAVE AND NEVER HAD MELANOMA (the emphasis is mine), pregnancy is a risk factor for developing melanoma much as frequent sun exposure and family medical history are risk factors for developing melanoma. This increased risk of developing melanoma disappears within a year or two after giving birth.
While I find this study interesting, it does not address the question we often get on this forum. Namely, "I had melanoma. It is gone now. If I get pregnant, will the pregnancy increase my risk of the melanoma coming back?" This study did NOT address that question and provides no data about that situation. However, as the study authors state and Anonymous (above) points out, pregnancy does suppress the immune system and this might be a reason why melanomas pop up more frequently in the first post-partum year. If that is the case, one would assume that pregnancy would also be a risk factor for melanoma recurrences. But it would just be a risk factor, not a direct trigger.
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- August 25, 2013 at 6:01 pm
The full text of this article is available at no cost here: http://www.sciencedirect.com/science/article/pii/S0959804913005583 I don't know how long it will be available for free.
The statistical methods here are pretty heavy-duty and I'm not sure I am reading them correctly. But my understanding is that of approximately 16,000 female melanoma patients diagnosed in the years from 1998–2008, 306 were diagnosed with melanoma within a year after childbirth. This is approximately twice as many melanoma diagnoses than for women who developed melanoma more than one year after giving birth.
The authors conclude that for women who DO NOT HAVE AND NEVER HAD MELANOMA (the emphasis is mine), pregnancy is a risk factor for developing melanoma much as frequent sun exposure and family medical history are risk factors for developing melanoma. This increased risk of developing melanoma disappears within a year or two after giving birth.
While I find this study interesting, it does not address the question we often get on this forum. Namely, "I had melanoma. It is gone now. If I get pregnant, will the pregnancy increase my risk of the melanoma coming back?" This study did NOT address that question and provides no data about that situation. However, as the study authors state and Anonymous (above) points out, pregnancy does suppress the immune system and this might be a reason why melanomas pop up more frequently in the first post-partum year. If that is the case, one would assume that pregnancy would also be a risk factor for melanoma recurrences. But it would just be a risk factor, not a direct trigger.
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- August 25, 2013 at 6:01 pm
The full text of this article is available at no cost here: http://www.sciencedirect.com/science/article/pii/S0959804913005583 I don't know how long it will be available for free.
The statistical methods here are pretty heavy-duty and I'm not sure I am reading them correctly. But my understanding is that of approximately 16,000 female melanoma patients diagnosed in the years from 1998–2008, 306 were diagnosed with melanoma within a year after childbirth. This is approximately twice as many melanoma diagnoses than for women who developed melanoma more than one year after giving birth.
The authors conclude that for women who DO NOT HAVE AND NEVER HAD MELANOMA (the emphasis is mine), pregnancy is a risk factor for developing melanoma much as frequent sun exposure and family medical history are risk factors for developing melanoma. This increased risk of developing melanoma disappears within a year or two after giving birth.
While I find this study interesting, it does not address the question we often get on this forum. Namely, "I had melanoma. It is gone now. If I get pregnant, will the pregnancy increase my risk of the melanoma coming back?" This study did NOT address that question and provides no data about that situation. However, as the study authors state and Anonymous (above) points out, pregnancy does suppress the immune system and this might be a reason why melanomas pop up more frequently in the first post-partum year. If that is the case, one would assume that pregnancy would also be a risk factor for melanoma recurrences. But it would just be a risk factor, not a direct trigger.
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- August 25, 2013 at 7:12 pm
Probably not totally. Hope the immune system can keep it below the detectable or spread level.
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- August 25, 2013 at 7:12 pm
Probably not totally. Hope the immune system can keep it below the detectable or spread level.
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- August 25, 2013 at 7:12 pm
Probably not totally. Hope the immune system can keep it below the detectable or spread level.
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- August 25, 2013 at 8:11 pm
Ok, so what you're saying, so I understand, is a Stage I thin melanoma, for instance, that is removed either totally w/ biopsy or w/ biopsy + WLE. . . the surgery really does not cut the melanoma totally out, some is probably left somewhere in the body & you just hope it doesn't form a tumor somewhere? If that is the case, then why not offer immunotherapy for those patients?
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- August 25, 2013 at 8:11 pm
Ok, so what you're saying, so I understand, is a Stage I thin melanoma, for instance, that is removed either totally w/ biopsy or w/ biopsy + WLE. . . the surgery really does not cut the melanoma totally out, some is probably left somewhere in the body & you just hope it doesn't form a tumor somewhere? If that is the case, then why not offer immunotherapy for those patients?
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- August 25, 2013 at 8:11 pm
Ok, so what you're saying, so I understand, is a Stage I thin melanoma, for instance, that is removed either totally w/ biopsy or w/ biopsy + WLE. . . the surgery really does not cut the melanoma totally out, some is probably left somewhere in the body & you just hope it doesn't form a tumor somewhere? If that is the case, then why not offer immunotherapy for those patients?
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