title: Effect of childbirth after treatment on long-term survival from breast cancer.
abstract: BACKGROUND
  This study quantified long-term absolute and relative mortality risks of survivors of breast cancer with subsequent childbirth.
  
  
  METHODS
  The Singapore Birth Register (n = 319,437), Swedish Multi-Generation Register (n = 11 million) and population-based cancer registries were linked to identify 492 women with childbirth after breast cancer. For these women, cumulative mortality risks and standardized mortality ratios (SMRs) were calculated and compared with those of 8529 women aged less than 40 years with breast cancer without subsequent childbirth, and with those predicted by Adjuvant! Online.
  
  
  RESULTS
  Women with subsequent childbirth had a lower 15-year cumulative overall mortality rate than other women with breast cancer (16.8 (95 per cent confidence interval (c.i.) 13.3 to 20.9) versus 40.7 (39.5 to 41.9) per cent), but a higher relative mortality risk than the background population (SMR 13.6, 95 per cent c.i. 10.6 to 17.3). Mortality risks decreased significantly with increasing interval between diagnosis and subsequent childbirth. Mean 10-year cumulative mortality risks of women with subsequent childbirth were within the range of 10-year mortality predicted by Adjuvant! Online for women with T1 N0 tumours in otherwise perfect health.
  
  
  CONCLUSIONS
  This study reinforced the view that pregnancy after breast cancer is not detrimental to survival. However, women who gave birth after this diagnosis had substantially higher mortality risks than young women in the general population. This information may be a valuable addition to routine mortality estimates.
authors.affiliation: Centre for Molecular Epidemiology, Investigative Medicine Unit, National University Health System, Singapore. ephhmv@nus.edu.sg
authors.forename: H M
authors.initials: HM
authors.lastname: Verkooijen
authors.forename: G H
authors.initials: GH
authors.lastname: Lim
authors.forename: K
authors.initials: K
authors.lastname: Czene
authors.forename: V
authors.initials: V
authors.lastname: Bhalla
authors.forename: K Y
authors.initials: KY
authors.lastname: Chow
authors.forename: K P L
authors.initials: KP
authors.lastname: Yap
authors.forename: K S
authors.initials: KS
authors.lastname: Chia
authors.forename: M
authors.initials: M
authors.lastname: Hartman
mesh_terms: D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000401:mortality* / Q000628:therapy; D002648:Child; D005260:Female; D006801:Humans; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000401:mortality*; D012042:Registries; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult