ASPO Abstracts
Risk of fetal death in a population-based sample of 65,000 adolescent and young adult women with a history of cancer
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2022
Abstract Body:
Purpose of the study: To estimate risk of fetal death in adolescent and young adult (AYA) women with a history of cancer.Methods: We identified women diagnosed with cancer at ages 15-39 years between January 1, 1995 and December 31, 2015 using population-based data from the Texas Cancer Registry. We linked these data to fetal death certificates to identify fetal deaths through December 31, 2016. Fetal death certificates are filed for fetuses weighing ‚â•350 grams or gestational age ‚â•20 weeks. We estimated a standardized fetal mortality ratio of observed fetal deaths per 1,000 live births in AYA women to expected fetal deaths per 1,000 live births in women without cancer, summed across strata of age and race and ethnicity. We also estimated cumulative incidence of fetal death, accounting for AYA death as a competing event. Results: A total of 65,804 AYA women with cancer (54.6% non-Hispanic White, 12.3% non-Hispanic Black, 33.0% Hispanic) contributed 522,819 person-years of follow-up; 69 fetal deaths occurred to 64 women after diagnosis. Mean time from diagnosis to first post-diagnosis fetal death was 4.4 years (SD=3.4 years); mean gestational age at fetal death was 27.9 weeks (SD=7.1 weeks). The fetal mortality rate in AYA women was 27% higher than the general population (standardized fetal mortality ratio 127.4, 95% CI 98.9, 161.5). Cumulative incidence of fetal death was 0.07% (95% CI 0.05, 0.09) at five years and 0.11% (95% CI 0.08, 0.14) at ten years after diagnosis. Five-year cumulative incidence of fetal death differed by cancer type, race and ethnicity, and age at diagnosis (all p<0.01). For example, five-year cumulative incidence ranged from 0.01% (95% CI 0.00, 0.05) for breast cancer to 0.13% (95% CI 0.07, 0.22) for thyroid cancer. Five-year cumulative incidence was higher in non-Hispanic Black (0.13%, 95% CI 0.06, 0.23) and Hispanic (0.10%, 95% CI 0.06, 0.15) compared to White (0.04%, 95% CI 0.02, 0.06) women. Conclusions: Although overall risk is low, AYA women experience excess fetal deaths compared to women without cancer, especially non-Hispanic Black and Hispanic women. Findings should inform fertility counseling for AYA women, and future studies should examine mechanisms of disparities and strategies to improve birth equity for AYA women.
Keywords: Adolescent and young adult; cancer survivor; reproductive health; population-based