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Background/objectives: Advances in cancer management have resulted in improved survival rates, particularly in children and young adults. However, treatment may adversely affect reproductive outcomes among female cancer survivors. The objective of this study was to investigate their risk of adverse perinatal outcomes compared to the general population. Design/methods: We performed a population-based analysis, including all female cancer survivors diagnosed before the age of 40 years between 1981 and 2012. Pregnancy and perinatal complications were identified through linkage of the Scottish Cancer Registry with hospital discharge records based on the Community Health Index (CHI) database. We compared 1,629 female cancer survivors with a first ever singleton pregnancy after diagnosis, with controls matched on age, deprivation quintile, and year of cancer diagnosis selected from the general population (n = 8,899). Relative risks and 95%-confidence intervals of perinatal risks were calculated using log-binomial regression. Results: Survivors were more likely to give birth before 37 weeks of gestation (relative risk (RR]) 1.32, 95%-CI 1.10–1.59), but did not show an increased risk of low birth weight (<2.5kg: RR 1.15, 95%-CI 0.94–1.39), and were less likely to give birth to offspring small for gestational age (RR 0.81, 95%-CI 0.68–0.98). Operative delivery and postpartum haemorrhage were more common but approached rates in controls with more recent diagnosis. The risk of congenital abnormalities was not increased (RR 1.01, 95%-CI 0.85–1.20). Conclusion: Cancer survivors have an increased risk of premature delivery and postpartum haemorrhage, but their offspring are not at increased risk for low birth weight or congenital abnormalities. In recent decades there has been a normalisation of delivery method in cancer survivors, nevertheless careful management remains appropriate particularly for those diagnosed in childhood. [ABSTRACT FROM AUTHOR]

Study Question: What is the impact of cancer in females aged ≤39 years on subsequent chance of pregnancy?Summary Answer: Cancer survivors achieved fewer pregnancies across all cancer types, and the chance of achieving a first pregnancy was also lower.What Is Known Already: The diagnosis and treatment of cancer in young females may be associated with reduced fertility but the true pregnancy deficit in a population is unknown.Study Design, Size, Duration: We performed a retrospective cohort study relating first incident cancer diagnosed between 1981 and 2012 to subsequent pregnancy in all female patients in Scotland aged 39 years or less at cancer diagnosis (n = 23 201). Pregnancies were included up to end of 2014. Females from the exposed group not pregnant before cancer diagnosis (n = 10 271) were compared with general population controls matched for age, deprivation quintile and year of diagnosis.Participants/materials, Setting, Methods: Scottish Cancer Registry records were linked to hospital discharge records to calculate standardized incidence ratios (SIR) for pregnancy, standardized for age and year of diagnosis. Linkage to death records was also performed. We also selected women from the exposed group who had not been pregnant prior to their cancer diagnosis who were compared with a matched control group from the general population. Additional analyses were performed for breast cancer, Hodgkin lymphoma, leukaemia, cervical cancer and brain/CNS cancers.Main Results and the Role Of Chance: Cancer survivors achieved fewer pregnancies: SIR 0.62 (95% CI: 0.60, 0.63). Reduced SIR was observed for all cancer types. The chance of achieving a first pregnancy was also lower, adjusted hazard ratio = 0.57 (95% CI: 0.53, 0.61) for women >5 years after diagnosis, with marked reductions in women with breast, cervical and brain/CNS tumours, and leukaemia. The effect was reduced with more recent treatment period overall and in cervical cancer, breast cancer and Hodgkin lymphoma, but was unchanged for leukaemia or brain/CNS cancers. The proportion of pregnancies that ended in termination was lower after a cancer diagnosis, and the proportion ending in live birth was higher (78.7 vs 75.6%, CI of difference: 1.1, 5.0).Limitations, Reasons For Caution: Details of treatments received were not available, so the impact of specific treatment regimens on fertility could not be assessed. Limited duration of follow-up was available for women diagnosed in the most recent time period.Wider Implications Of the Findings: This analysis provides population-based quantification by cancer type of the effect of cancer and its treatment on subsequent pregnancy across the reproductive age range, and how this has changed in recent decades. The demonstration of a reduced chance of pregnancy across all cancer types and the changing impact in some but not other common cancers highlights the need for appropriate fertility counselling of all females of reproductive age at diagnosis.Study Funding/competing Interest(s): This study was funded by NHS Lothian Cancer and Leukaemia Endowments Fund. Part of this work was undertaken in the MRC Centre for Reproductive Health which is funded by the MRC Centre grant MR/N022556/1. RAA has participated in Advisory Boards and/or received speaker's fees from Beckman Coulter, IBSA, Merck and Roche Diagnostics. He has received research support from Roche Diagnostics, Ansh labs and Ferring. The other authors have no conflicts to declare. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To assess the risk of death in patients who survive at least 5years after diagnosis of childhood, adolescent or young adult cancer. Patients and Methods: This was a population-based retrospective cohort study using linked national cancer registry and mortality records in Scotland. The study population consisted of 5229 individuals who were diagnosed with cancer before the age of 25years between 1981 and 2003, and who survived at least 5years after the date of diagnosis of their primary cancer. Indirect standardisation was used to calculate mortality ratios standardised for age and sex and absolute excess risks (AERs) compared to the general Scottish population. Results: During 58,358 person-years of follow-up, there were 359 deaths among the cohort of cancer survivors. The overall SMR was 6.1 (95% confidence interval (CI) 5.5–6.7) and AER 51 (45–58) per 10,000 person-years. Largely because of age- and sex-related differences in background mortality, SMRs were higher in patients diagnosed at 0–14years (SMR 11.0, 95% CI 9.3–12.9) than 15–24years (4.7, 4.1–5.3), and in females (9.2, 7.8–10.8) than males (4.8, 4.2–5.5). SMRs and AERs varied substantially by primary cancer and by underlying cause of death. In general, SMRs were little altered by standardisation for an area-based indicator of socio-economic deprivation. Adjusted for age and sex, the risk of death was significantly lower in five-year survivors diagnosed during 1998–2003 compared to those diagnosed during 1981–1985 (Relative hazard ratio, 0.54, 95% CI 0.36–0.81). Conclusion: Long-term survivors of cancer in childhood and young adulthood remain at higher risk of mortality than the general population, although the absolute risk of death is low and the excess risk has decreased over time. [Copyright &y& Elsevier]

Abstract: Completeness of ascertainment of breast cancer cases by the Scottish Cancer Registry (SCR) was assessed by independent comparison with five clinical trials databases, comprising 2621 patients and spanning the total period of diagnosis 1978–2000. Overall, ascertainment was estimated to exceed 98%, although 0.3% of matched cases were misclassified as carcinoma in situ by the SCR. These results support the validity of national estimates of incidence of, and survival from, breast cancer in Scotland. [Copyright &y& Elsevier]

Two letters to the editor are presented in response to the article "UK Cancer Survival Statistics," by V. Beral and R. Peto, published in the August 14, 2010 issue, including a comment that such article does not reflect recent cancer registration practice in Great Britain, and a commendation on the authors' use of acquired data in assessing cancer registration.

Background: Significant advances in the management of patients with lymphoid and myeloid malignancies entered clinical practice in the early 2000's. The EUROCARE-5 study database provides an opportunity to assess the impact of these changes at the population level by country in Europe. We provide survival estimates for clinically relevant haematological malignancies (HM), using the International Classification of Diseases for Oncology 3, by country, gender and age in Europe. Methods: We estimated age-standardised relative survival using the complete cohort approach for 625,000 adult patients diagnosed in 2000-2007 and followed up to 2008. Survival information was provided by 89 participating cancer registries from 29 European countries. Mean survival in Europe was calculated as the population weighted average of country-specific estimates. Results: On average in Europe, 5-year relative survival was highest for Hodgkin lymphoma (81%; 40,625 cases), poorest for acute myeloid leukaemia (17%; 57,026 cases), and intermediate for non-Hodgkin lymphoma (59%; 329,204 cases), chronic myeloid leukaemia (53%; 17,713 cases) and plasma cell neoplasms (39%; 94,024 cases). Survival was generally lower in Eastern Europe and highest in Central and Northern Europe. Wider between country differences (>10%) were observed for malignancies that benefited from therapeutic advances, such as chronic myeloid leukaemia, chronic lymphocytic leukaemia, follicular lymphoma, diffuse large B-cell lymphoma and multiple myeloma. Lower differences (<10%) were observed for Hodgkin lymphoma. Conclusions: Delayed or reduced access to innovative and appropriate therapies could plausibly have contributed to the observed geographical disparities between European regions and countries. Population based survival by morphological sub-type is important for measuring outcomes of HM management. To better inform quality of care research, the collection of detailed clinical information at the population level should be prioritised. [ABSTRACT FROM AUTHOR]

Abstract: To explore possible causes of the poor survival of Scottish lung cancer patients, a retrospective registry-based audit was conducted comparing demography, treatment and survival of 3833 Scottish patients and 2073 from British Columbia (BC). Patients from Scotland were older, had a lower rate of pathological confirmation (74% vs 89%, p <0.001), but more squamous (51% vs 31%, p <0.001) or small cell (SCLC) (18% vs 15%, p =0.005) cancers. Fewer Scottish patients received any treatment (57% vs 66%, p <0.001) or treatment aimed at cure (14% vs 26%, p <0.001). Survival was lower in Scotland (median 3.6 months vs 7.3 months; 5% vs 10% 5-year overall survival, p <0.001), irrespective of treatment intent (potentially curative treatment median survival 20.9 months vs 34.0 months, 5-year overall survival 29% vs 34%, p <0.001; palliative treatment 5.0 months vs 6.3 months (p <0.001) and no treatment 1.4 months vs 2.5 months (p <0.001)). With treatment intent included in a multivariate analysis, the hazard ratio for death for lung cancer patients in Scotland compared to British Columbia was 1.5. Relative survival was higher in BC (38% at 1 year and 12% at 5 years vs 22% and 6%, p <0.001), indicating that life expectancy differences between the two countries was not the explanation. Reduced levels of treatment could only partially explain survival differences and other unknown factors related to lifestyle differences such as diet and smoking, co-morbid diseases, population genetics or cancer biology, may be important and warrant further exploration. [Copyright &y& Elsevier]