scholarly journals Pregnancy After Breast Cancer: A Systematic Review and Meta-Analysis

2021 ◽  
pp. JCO.21.00535
Author(s):  
Matteo Lambertini ◽  
Eva Blondeaux ◽  
Marco Bruzzone ◽  
Marta Perachino ◽  
Richard A. Anderson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
General Population ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Subsequent Pregnancy ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Reproductive Outcomes ◽  
Increased Risk

PURPOSE Many patients and physicians remain concerned about the potential detrimental effects of pregnancy after breast cancer (BC) in terms of reproductive outcomes and maternal safety. This systematic review and meta-analysis aimed at providing updated evidence on these topics. METHODS A systematic literature review was conducted to identify studies including patients with a pregnancy after BC (PROSPERO number CRD42020158324). Likelihood of pregnancy after BC, their reproductive outcomes, and maternal safety were assessed. Pooled relative risks, odds ratios (ORs), and hazard ratios (HRs) with 95% CIs were calculated using random effects models. RESULTS Of 6,462 identified records, 39 were included involving 8,093,401 women from the general population and 112,840 patients with BC of whom 7,505 had a pregnancy after diagnosis. BC survivors were significantly less likely to have a subsequent pregnancy compared with the general population (relative risk, 0.40; 95% CI, 0.32 to 0.49). Risks of caesarean section (OR, 1.14; 95% CI, 1.04 to 1.25), low birth weight (OR, 1.50; 95% CI, 1.31 to 1.73), preterm birth (OR, 1.45; 95% CI, 1.11 to 1.88), and small for gestational age (OR, 1.16; 95% CI, 1.01 to 1.33) were significantly higher in BC survivors, particularly in those with previous chemotherapy exposure, compared with the general population. No significantly increased risk of congenital abnormalities or other reproductive complications were observed. Compared to patients with BC without subsequent pregnancy, those with a pregnancy had better disease-free survival (HR, 0.66; 95% CI, 0.49 to 0.89) and overall survival (HR, 0.56; 95% CI, 0.45 to 0.68). Similar results were observed after correcting for potential confounders and irrespective of patient, tumor, and treatment characteristics, pregnancy outcome, and timing of pregnancy. CONCLUSION These results provide reassuring evidence on the safety of conceiving in BC survivors. Patients' pregnancy desire should be considered a crucial component of their survivorship care plan.

scholarly journals Systematic review and meta-analysis of female lifestyle factors and risk of recurrent pregnancy loss

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ka Ying Bonnie Ng ◽  
George Cherian ◽  
Alexandra J. Kermack ◽  
Sarah Bailey ◽  
Nick Macklon ◽  
...  
Keyword(s):  
Systematic Review ◽  
General Population ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Meta Analysis ◽  
Lifestyle Factors ◽  
Caffeine Intake ◽  
Increased Risk ◽  
Secondary Outcomes

AbstractIt is known that lifestyle factors affect sporadic miscarriage, but the extent of this on RPL (recurrent pregnancy loss) is less well known. A systematic review and meta-analysis was performed to assess the associations between lifestyle factors and RPL. Studies that analysed RPL in the context of BMI, smoking, alcohol and caffeine intake were included. The primary and secondary outcomes were odds of having RPL in the general population and odds of further miscarriage, respectively. Underweight and women with BMI > 25 are at higher odds of RPL in the general population (OR 1.2, 95% CI 1.12–1.28 and OR 1.21, 95% CI 1.06–1.38, respectively). In women with RPL, having BMI > 30 and BMI > 25 has increased odds of further miscarriages (OR 1.77, 95% CI 1.25–2.50 and OR 1.35, 95% CI 1.07–1.72, respectively). The quality of the evidence for our findings was low or very low. Being underweight and BMI > 25 contributes significantly to increased risk of RPL (general population). BMI > 25 or BMI > 30 increases the risk of further miscarriages (RPL population). Larger studies addressing the effects of alcohol, cigarette smoking and caffeine on the risk of RPL with optimisation of BMI in this cohort of women are now needed.

Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and meta-analysis

2015 ◽  
Vol 46 (2) ◽  
pp. 237-251 ◽  
Author(s):  
S. Honings ◽  
M. Drukker ◽  
R. Groen ◽  
J. van Os
Keyword(s):  
Systematic Review ◽  
General Population ◽  
Meta Analysis ◽  
Full Range ◽  
Effect Sizes ◽  
Psychotic Experiences ◽  
Increased Risk ◽  
Self Harm ◽  
Specific Association ◽  
Residual Confounding

BackgroundRecent studies suggest that psychotic experiences (PE) in the general population are associated with an increased risk of self-injurious behaviour. Both the magnitude of this association and the level of adjustment for confounders vary among studies. A meta-analysis was performed to integrate the available evidence. The influence of possible confounders, including variably defined depression, was assessed.MethodA systematic review and meta-analysis was conducted including general population studies reporting on the risk of self-injurious behaviour in individuals with PE. Studies were identified by a systematic search strategy in Pubmed, PsycINFO and Embase. Reported effect sizes were extracted and meta-analytically pooled.ResultsThe risk of self-injurious behaviour was 3.20 times higher in individuals with PE compared with those without. Subanalyses showed that PE were associated with self-harm, suicidal ideation as well as suicidal attempts. All studies had scope for considerable residual confounding; effect sizes adjusted for depression were significantly smaller than effect sizes unadjusted for depression. In the longitudinal studies, adjustment for psychopathology resulted in a 74% reduction in excess risk.ConclusionsPE are associated with self-injurious behaviour, suggesting they have potential as passive markers of suicidality. However, the association is confounded and several methodological issues remain, particularly how to separate PE from the full range of connected psychopathology in determining any specific association with self-injurious behaviour. Given evidence that PE represent an indicator of severity of non-psychotic psychopathology, the association between PE and self-injurious behaviour probably reflects a greater likelihood of self-injurious behaviour in more severe states of mental distress.

scholarly journals The risk of infections in adult patients with systemic lupus erythematosus: systematic review and meta-analysis

Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 60-72 ◽  
Author(s):  
José María Pego-Reigosa ◽  
Lindsay Nicholson ◽  
Nick Pooley ◽  
Sue Langham ◽  
Nina Embleton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Herpes Zoster ◽  
General Population ◽  
Meta Analysis ◽  
Severe Infection ◽  
Infection Risk ◽  
Sensitivity Analyses ◽  
Healthy Controls ◽  
Increased Risk ◽  
The Impact

Abstract Objectives We conducted a systematic review and meta-analysis to determine the magnitude of infection risk in patients with SLE and evaluate the effect of general and SLE-related factors on infection risk. Methods We searched MEDLINE and Embase from inception to July 2018, screening for observational studies that evaluated infection risk in patients with SLE compared with the general population/healthy controls. Outcomes of interest included overall severe infection, herpes zoster infection/reactivation, opportunistic infections, pneumonia and tuberculosis. Random-effects models were used to calculate pooled risk ratios (RRs) for each type of infection. Sensitivity analysis assessed the impact of removing studies with high risk of bias. Results Eleven retrospective or prospective cohort studies were included in the meta-analysis: overall severe infection (n = 4), pneumonia (n = 6), tuberculosis (n = 3) and herpes zoster (n = 2). Pooled RRs for overall severe infection significantly increased for patients with SLE compared with the general population/healthy controls [RR 2.96 (95% CI 1.28, 6.83)]. Pooled RRs for pneumonia, herpes zoster and tuberculosis showed significantly increased risk compared with the general population/healthy controls [RR 2.58 (1.80, 3.70), 2.50 (2.36, 2.65) and 6.11 (3.61, 10.33), respectively]. Heterogeneity and evidence of publication bias were present for all analyses, except herpes zoster. Sensitivity analyses confirmed robustness of the results. Conclusion Patients with SLE have significantly higher risk of infection compared with the general population/healthy controls. Efforts to strengthen strategies aimed at preventing infections in SLE are needed. Protocol registration PROSPERO number: CRD42018109425.

scholarly journals The association between ATM variants and risk of breast cancer: a systematic review and meta-analysis

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masoumeh Moslemi ◽  
Yousef Moradi ◽  
Hojat Dehghanbanadaki ◽  
Hamed Afkhami ◽  
Mansoor Khaledi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Meta Analysis ◽  
Predictive Ability ◽  
Case Control ◽  
Ataxia Telangiectasia Mutated ◽  
Case Control Studies ◽  
Predisposing Factor ◽  
Increased Risk ◽  
Atm Gene

Abstract Background Ataxia telangiectasia-mutated (ATM) gene contributes to repair damaged DNA and to regulate cell cycle; therefore, ATM variants seem to increase breast cancer risk; however, the results are controversial. So we conducted a systematic review and meta-analysis to clarify the pooled association between various ATM variants and the risk of breast cancer. Methods The relevant studies were searched through Scopus, Web of Science, PubMed and Cochrane. Stratified and subgroup analyses were performed to explore heterogeneity between studies and assess effects of study quality. The pooled estimates logarithm with standard error logarithm of odds ratio and relative risk with confidence interval were calculated. Results This study revealed that there is association between ATM variants and the risk of breast cancer; according to the seven adjusted case-control studies, OR of this association was estimated as 1.67 (95%CI: 0.73–3.82), according to nine unadjusted case-control studies, the crude OR was 2.27 (95% CI: 1.17–4.40) and according to two cohorts, the RR was estimated as 1.68 (95% CI: 1.17–2.40). Conclusions The ATM variants are associated with an increased risk of breast cancer that ATM V2424G mutation is detected as the most predisposing factor while ATM D1853V, L546V, and S707P variants have the least predictive ability.

Short versus long duration of adjuvant trastuzumab (T) in HER2+ breast cancer: A systematic review and meta-analysis of randomized controlled trials (RCTs).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e12057-e12057 ◽  
Author(s):  
Qurat Ul Ain Riaz Sipra ◽  
Irbaz Bin Riaz ◽  
Muhammad Husnain ◽  
Ammad Raina ◽  
Ahsan Khan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Early Stage ◽  
Meta Analysis ◽  
Unmet Need ◽  
Disease Free Survival ◽  
Significant Heterogeneity ◽  
Cardiac Events ◽  
Her2 Breast Cancer ◽  
Study Heterogeneity

e12057 Background: Several RCTs have evaluated a shorter duration of T ( < 12 months) with hopes of similar efficacy, reduced cardiotoxicity, cost and burden of treatment. Of the 5 major studies, PERSPHONE showed that 6 months was non-inferior compared to 12 months. However, four additional studies of shorter duration failed to demonstrate non-inferiority. Therefore, we performed an updated systematic review and a meta-analysis to assess the optimal duration of adjuvant T. Methods: MEDLINE, EMBASE, Cochrane, Scopus and conference proceedings were searched to identify RCTs comparing one year of adjuvant T with a shorter duration in early-stage HER2+ breast cancer. The DerSimonian-Laird random-effects Meta-Analysis was performed using CMAv3 software to derive pooled Hazard Ratio (HR) estimates for overall survival (OS, Disease-Free Survival (DFS) and Odds Ratio(OR) estimates of cardiac toxicity. Q-test was used to assess between-study heterogeneity; I2 statistic was computed to express the percentage of the total observed variability due to study heterogeneity. The risk for bias was assessed using the Cochrane Collaboration’s tool. Results: We screened 1772 citations and identified 5 studies(n = 11,377) for analysis. 5691 patients were randomized to 12 months of adjuvant T while 5686 were randomized to a shorter duration (3 studies evaluated 6 vs 12 months, 2 studies evaluated 9 weeks vs 12 months). OS (HR, 1.16, 95% CI 1.03-1.31, P= 0.015,I2 0.00, p= 0.837) and DFS (HR, 1.14, 95% CI 1.02-1.26 , P = 0.016,I2 14.90, p= 0.319) were significantly worse in patients receiving shorter duration T as compared to 12 months. Cardiotoxicity was significantly higher in the 12 month group vs shorter duration (OR, 2.10, 95% CI 1.58-2.80, p = 0.000 ,I2 51.182, p= 0.085). Grade 3/4 cardiac events and cardiac events leading to discontinuation of therapy were significantly higher in patients receiving 12 months (HR 2.06, 95% CI 1.60-2.63, P = 0.000, I2 3.967, p= 0.384). There was no significant heterogeneity among studies. Risk of bias was low. Conclusions: Twelve months of adjuvant T is associated with significantly better DFS and OS compared to a shorter duration. As such, 12 months should remain the standard of care for most patients. There is an unmet need to identify lower risk groups which might do well with from shorter duration of HER2-directed therapy.

scholarly journals Overweight and prognosis in triple-negative breast cancer patients: a systematic review and meta-analysis

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Sixten Harborg ◽  
Robert Zachariae ◽  
Julia Olsen ◽  
Maja Johannsen ◽  
Deirdre Cronin-Fenton ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Overall Survival ◽  
Triple Negative Breast Cancer ◽  
Observational Studies ◽  
Triple Negative ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Free Survival ◽  
Disease Free

AbstractWe conducted a systematic review and meta-analysis investigating the association between overweight and outcome in triple-negative breast cancer (TNBC) patients. We searched PubMed and Embase using variations of the search terms triple-negative breast cancer (population), overweight and/or obesity (exposure), and prognosis (outcome). Based on the World Health Organization guidelines for defining overweight, we included longitudinal observational studies, which utilized survival statistics with hazard ratios (HRs) in our analysis. The included studies measured body mass index at the time of diagnosis of TNBC and reported disease-free survival and/or overall survival. Study quality was assessed with the Newcastle-Ottawa Scale and study data were extracted using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist, independently by two authors. Random-effects models were used to combine the effect sizes (HRs), and the results were evaluated and adjusted for possible publication bias. Thirteen studies of 8,944 TNBC patients were included. The meta-analysis showed that overweight was associated with both shorter disease-free survival (HR = 1.26; 95%CI: 1.09–1.46) and shorter overall survival (HR = 1.29; 95%CI: 1.11c1.51) compared to normal-weight. Additionally, our Bayesian meta-analyses suggest that overweight individuals are 7.4 and 9.9 times more likely to have shorter disease-free survival and overall survival, respectively. In conclusion, the available data suggest that overweight is associated with shorter disease-free and overall survival among TNBC patients. The results should be interpreted with caution due to possible publication bias.

scholarly journals Prognostic Role of PD-L1 Expression in Invasive Breast Cancer: A Systematic Review and Meta-Analysis

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 6090
Author(s):  
Magno Belém Cirqueira ◽  
Carolina Rodrigues Mendonça ◽  
Matias Noll ◽  
Leonardo Ribeiro Soares ◽  
Maria Auxiliadora de Paula Carneiro Cysneiros ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Invasive Breast Cancer ◽  
Meta Analysis ◽  
Growth Factor Receptor ◽  
Disease Free Survival ◽  
Clinicopathological Characteristics ◽  
Lymph Node Status ◽  
Epidermal Growth

Programmed death ligand 1 (PD-L1) has been investigated in various types of cancer; however, the role of PD-L1 expression in breast cancer remains controversial. We performed a systematic review and meta-analysis to assess the association of PD-L1 expression with clinicopathological variables, overall survival (OS), and disease-free survival (DFS) in invasive breast cancer. A total of 965 articles were included from CINAHL, Embase, PubMed, and Scopus databases. Of these, 22 studies encompassing 6468 cases of invasive breast cancer were included in the systematic review, and 15 articles were included in the meta-analysis. PD-L1 expression was associated with age ≥ 50 years, lymph node status-negative, progesterone receptor-negative, Ki67 ≥ 20%, and human epidermal growth factor receptor 2 (HER2)-negative. PD-L1 positivity was associated with worse OS (hazard ratio, HR, 2.39; 95% confidence interval, CI, 1.26–3.52; p =< 0.000); however, there was no significant improvement in DFS (HR 0.17; 95% CI −0.12–0.46; p =< 0.252). PD-L1 positivity was significantly associated with the clinicopathological characteristics of favorable and unfavorable prognoses. However, the final clinical outcome was associated with lower OS and had no significant association with DFS.

scholarly journals Dioxins Exposure and the Risk of Breast Cancer: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 13 (2) ◽  
Author(s):  
Nematollah Jaafarzadeh Haghighi ◽  
Amal Saki Malehi ◽  
Zeinab Ghaedrahmat
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
English Language ◽  
Meta Analysis ◽  
Breast Cancer Mortality ◽  
Positive Association ◽  
Great Distance ◽  
Organic Chemical ◽  
Significant Positive Association ◽  
Increased Risk

Context: Dioxins and dioxin-like chemicals composed of 419 compounds are a large group of compounds, including polychlorinated di-benzo-p-dioxins (PCDDs), dibenzofurans (PCDFs), and biphenyls (PCBs). Dioxins are extremely persistent in the environment and disperse in a great distance from the emission source, and bioaccumulation in the food chain is one of their critical properties. The incidence of breast cancer among Iranian women is about 30 to 35 per 100,000 cases. The present study is a systematic review of published studies in English language to discover the relationship between exposure to dioxin compounds and breast cancer. Methods: We conducted a comprehensive literature review utilizing PubMed, Embase, Scopus, and ISI web of science databases. The MeSH-based keywords used included Organic Chemical (MeSH) OR Dioxins (MeSH) AND cancer (MeSH) OR Breast cancer (MeSH) AND Breast disease (MeSH). Results: The review of the literature indicated a significant positive association between dioxins exposure and the risk of breast cancer. Only in one study, breast cancer mortality rate was reported in terms of exposure to dioxins, and standardized mortality rates (SMRs) were determined. Conclusions: Although there were limitations in this study, statistical analyses in various epidemiological studies demonstrated that dioxins exposure is linked to an increased risk of breast cancer.

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