Poster Presentation - SOMANZ ASM Society of Obstetric Medicine of Australia and New Zealand ASM 2023

Clinical audit of a maternal medicine service: women with cancer first presenting in pregnancy (#47)

Mia Harrison 1 , Mark P Umstad 1 2 , Wanda Cui 3 , Iniyaval Thevathasan 1 , Anna Krelle 4 , Sarah Price 1 4 5
  1. Royal Womens Hospital, Flemington, Victoria, Australia
  2. Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
  3. Department of Oncology , Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
  4. Department of Obstetric Medicine, Royal Women's Hospital, North Melbourne, Victoria, Australia
  5. Department of Obstetric Medicine, Frances Perry House, Ramsay Health, Melbourne, Victoria, Australia

Background: Internationally, around 1 in 2000 pregnancies are complicated by cancer and the incidence is increasing1. The reason for this is multifactorial, with potential factors being the increasing cancer prevalence in young persons2, advancing maternal age3, increasing body mass index and co-morbidities in women seeking pregnancy4, and advancements in routine testing such as non-invasive prenatal testing (NIPT) and ultrasonography leading to increased incidental diagnosis5. Although there is an international registry to report pregnancy outcomes in women who first present with cancer in pregnancy (INCIP)3, there is little published local data.

Aim: To describe the incidence of cancer first presenting in pregnancy in a single tertiary maternal medicine clinic, and the pregnancy outcomes.

Methods: A retrospective audit of all women attending the maternal medicine clinic of a tertiary maternity hospital between 1st October 2021 and 30th April 2023 was performed. Women with the first diagnosis of a cancer during pregnancy (not a recurrence) were included. Women were excluded if they were not pregnant, if there was no documentation of a cancer diagnosis, or if they had not planned to deliver by 1st October 2023. Within the relevant dates, the clinic lists were screened by reviewing the problem list in the electronic medical record. Coding data was reviewed to identify any potential subjects. Ethics was approved by The Royal Women’s Hospital Human Research Ethics Committee.

Results: Ten subjects met the inclusion criteria. The mean age was 32.6 years (range 23-43 years). Six women (60%) were nulliparous, and one woman (10%) used assisted reproductive technology to conceive. The cancer types and staging are shown in Table 1. One subject was diagnosed with Hodgkin’s lymphoma following an abnormal NIPT test, and two women with ovarian cancer were diagnosed on routine ultrasound. Five women (50%) had identifiable genetic mutations which predisposed them to the presenting cancer. The mean gestation of cancer diagnosis was 22 weeks (range 5-38 weeks). During pregnancy, cancer treatment consisted of surgery (50%) and chemotherapy (20%). Immediately post-partum, an additional 10% of subjects had surgery and 20% started chemotherapy. Only one subject had an expedited preterm delivery and delayed all cancer treatment until the post-partum period. Pregnancy outcomes are outlined in Table 1. One delivery is pending; EDD 10.09.23.

Conclusion: Although cancer in pregnancy is rare, most women have term deliveries and pregnancy outcomes are reassuring even in women who have cancer treatments during pregnancy. This is consistent with international data.

 

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  1. Stensheim H, Møller B, van Dijk T, Fosså SD. Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study. J Clin Oncol. Jan 01 2009;27(1):45-51. doi:10.1200/JCO.2008.17.4110
  2. Welfare AioHa. Cancer in adolescents and young adults in Australia. In: Government A, editor. 2023.
  3. Maggen C, Wolters VERA, Cardonick E, et al. Pregnancy and Cancer: the INCIP Project. Curr Oncol Rep. 02 05 2020;22(2):17. doi:10.1007/s11912-020-0862-7.
  4. Wolters V, Heimovaara J, Maggen C, et al. Management of pregnancy in women with cancer. Int J Gynecol Cancer. 03 2021;31(3):314-322. doi:10.1136/ijgc-2020-001776
  5. Amant F, Verheecke M, Wlodarska I, et al. Presymptomatic Identification of Cancers in Pregnant Women During Noninvasive Prenatal Testing. JAMA Oncol. Sep 2015;1(6):814-9. doi:10.1001/jamaoncol.2015.1883