Cancer cervical death rate

Seven times the risk of neonatal loss.

KAMUELA, HAWAII -- Babies of women with cervical cancer have very significantly elevated rates of neonatal death, according to results of a population-based study of maternal malignancies.

Women with cervical cancer were seven times more likely than other mothers to suffer a neonatal loss, Dr. Lloyd H. Smith reported at the annual meeting of the Pacific Coast Obstetrical and Gynecological Society.

There were six neonatal deaths reported among the 266 women in the study who had cervical cancer. The rate in the general population is 3 per 1,000.

"This phenomenon was a little bit startling. Looking at the literature, I don't think we have appreciated that this is the situation," said Dr. Smith, professor and chair of obstetrics and gynecology at the University of California at Davis.

"The obvious question is, is this somehow iatrogenic--are these babies dying at a higher rate because we're delivering women early--or is there some other phenomena, for example, unplanned, extremely premature delivery?" he asked.

More research needs to be done to elucidate the answers to these questions, along with myriad others raised in what was termed a "landmark" study by Dr. Vein Katz of Eugene, Ore., who gave a formal critique of the paper at the meeting.

What set the study apart from previous research on the subject was its scope. Dr. Smith and his associates compared virtually all infant birth and death certificates to maternal and neonatal hospital discharge records in California over a 6-year period, providing an unprecedented look at the rate of maternal malignancies in the population, the types of cancer most often diagnosed, and the maternal and infant outcomes.

Although the study focuses on California data, the findings are believed to be representative of the nation as a whole, Dr. Katz said.

Among 3,168,911 live, singleton births, 2,247 maternal-associated malignancies were diagnosed either during the prenatal period, at the time of delivery or during the 12 months after delivery. The reported rate of 0.7 cases of maternal malignancy per 1,000 live births is probably an underestimate, since cancer diagnosed and treated outside the hospital setting--malignant melanoma, for example--would not be captured in the data set.

Also, women with cancer who spontaneously aborted or chose to terminate their pregnancies were not included, so the true rate of maternal malignancy is probably closer to 1 in 1,000, a rate that is "not all that rare," Dr. Katz said.

Women with placental cancer and those with uterine cancer of unspecified type also had dramatically elevated neonatal death rates (44 times normal and 13.5 times normal, respectively), but the small number of women with those cancers made the connection less powerful, he explained. Just 15 women had placental cancer, and 39 had uterine cancer of unspecified type.

The most frequent neoplasms, in order, were breast cancer, thyroid cancer, cervical cancer, Hodgkin's disease, and ovarian cancer. Together, these malignancies constituted 61% of all cancer cases in the study. The high rate of thyroid cancer, 389 cases in 6 years, was "somewhat of a surprise," Dr. Smith said.

More than half of all cases, including the majority of breast, cervical, and thyroid cancers, were diagnosed in the postpartum period. "This means that they failed to be detected prenatally or at the time of delivery" said Dr. Smith. "This is a little concerning, and I really think this is a fruitful area to look into.

"Either our diagnostic efforts are missing these cases, or perhaps the physiologic changes of pregnancy are obscuring these cases." Hodgkin's disease, ovarian cancer, and leukemia were more likely to be diagnosed in the antepartum period.

The greatest risk factor for maternal malignancy was maternal age, with women over age 40 having almost a six times greater chance of being diagnosed with cancer than those aged 20-25. Women having four or more children were 1.5 times more likely than others to receive a cancer diagnosis during the prenatal period or in the year following delivery Similarly elevated risk was seen for women with private insurance as opposed to Medicare.

While maternal death and neonatal death were not statistically elevated in the cancer group as a whole, poorer than average outcomes were seen on many other fronts. The elevated odds ratio for one of these patients having a hysterectomy was 27.4; blood transfusion, 6.2; very-low-birth-weight baby, 2.9; and cesarean delivery 1.4