Fertility and abortion: A population-based comparison between women with cancer and those in childbearing age

Objectives: Concurrence of pregnancy and cancer diagnosis is increasingly frequent in Italy. The study aimed to compare women with pregnancy-associated cancers (PACs) to those of childbearing age, focusing on fertility, induced abortion, and miscarriage. Methods: The population-based study included women aged 15-49 years, both with and without PAC, who were residents in the area covered by the 19 participating Cancer Registries between 2003 and 2015 and identified by individual deterministic linkage with the Hospital Discharge Database. Results: Overall, 2,218,139 obstetrics hospitalizations occurred, covering delivery (75%), induced abortion (14%), and miscarriage (11%). Among 2409 women with PAC, 69% gave birth, 16% had an induced abortion and 15% a miscarriage. Compared with the reference population, the fertility rate in women with PACs was steadily lower (mean values 25.7/1000 vs 37.7/1000), while induced abortion (from 359/1000 - SRR 1.99, 95%CI 1.32-3.00 - in 2003 to 147/1000 - SRR 1.11, 95%CI 0.59-2.09 - in 2015) and miscarriage ratios exhibited a decreasing trend. Conclusion: These results are consistent with international literature and are probably due to advancements in diagnostic and therapeutic opportunities. This is the first Italian population-based study analysing fertility and pregnancy outcomes among women with PAC based on a reliable information on cancer diagnosis.