More women who were diagnosed with cancer as teens or young adults are surviving -- and many are having children of their own.
But their path isn't always easy. A new study published today in JAMA Oncology finds women who survived cancer between 15 and 39 years old may have an increased risk of complications with pregnancies and births, even years later.
Studies of girls who survived cancer up to age 14 have suggested that preterm birth and low birth weight babies are a risk, the authors of this study noted.
But this analysis is the first expansive study showing how women treated for cancer in childbearing age have fared with having babies, according to Dr. Ellie Ragsdale, an obstetrician and gynecologist at the University Hospitals Cleveland Medical Center.
She said that many women don't realize that past cancer treatment could affect their future pregnancies.
"It's generally a surprise to them," Ragsdale said. "I think the biggest thing for us is making the patients aware that they can have the reproductive future that they want."
Researchers from the University of North Carolina, Chapel Hill examined data from 2,598 women in the North Carolina Central Cancer Registry who had cancer as adolescents or young adults and went on to give birth, as well as women who were diagnosed with cancer while pregnant.
They found that, overall, premature deliveries and newborns with low birth weight were more likely for this group compared to women who had not been treated for cancer in the past. There was also a small, but statistically significant increase in the number of these women, who gave birth via cesarean section.
The mean time between cancer diagnosis and pregnancy was about 3.1 years and the mean age of women at cancer diagnosis was 28 years.
Certain kinds of cancer and treatments women received appeared to be associated with complications. Women who had chemotherapy without radiation were more likely to have prematurely born infants. Cesarean deliveries were also increased among this group, compared to women without cancer. Women who survived gynecologic cancers by having surgery only, were more likely to give birth to preterm infants. Additionally, women who had chemotherapy to treat non-Hodgkin's lymphoma and breast cancer were the most likely to give birth prematurely or have an infant with low birth weight.
Ragsdale said when women who have had cancer treatment come in to her office, high-risk specialists will work with them to understand how the cancer and treatment may affect their pregnancies.
"There is a lot of fear of 'Can I have a healthy pregnancy?,'" said Ragsdale. She said some women are already given extra monitoring, but that further study may help oncologists figure out how to best treat cancer, while minimizing harm to the reproductive organs.
Not surprisingly, women who were diagnosed with cancer while being pregnant had the highest rates of complications, but increased risk was also seen when there were months or years between cancer treatment and pregnancy. The study authors theorize that chemotherapy treatments could impair cardiovascular or pulmonary function for some time.
They said more study would be necessary to assess risk for a wider variety of women, who may have been treated for various cancers and with many different treatments.
The authors suggest that counseling women who had cancer would help, both before they are pregnant and during pregnancy. Additionally, they recommend more long-term monitoring for these survivors.