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Comment & Response
January 2018

Timing of Pregnancy and Survival in Women With Breast Cancer

Author Affiliations
  • 1Hurley Medical Center, Flint, Michigan
  • 2Michigan State University, Flint
JAMA Oncol. 2018;4(1):131. doi:10.1001/jamaoncol.2017.2711

To the Editor Iqbal et al1 reported no survival difference in pregnant compared with nonpregnant women with a breast cancer diagnosis in a recent JAMA Oncology article. The 5-year actuarial survival rate was 97% for women who had pregnancy 6 months or more after diagnosis of breast cancer vs 88% for women with no pregnancy, with age-adjusted hazard ratio of 0.22.1 According to eTable 6 in their study, 53% of the analyzed patients are labeled with unknown tumor size. Moreover, 55% of the patients’ lymph node status was unknown. Such a degree of missing data can affect the authors’ conclusion given the survival relationship with both tumor size and nodal status.2 Despite correlation between tumor size and nodal involvement, the prognostic value of the 2 factors is independent. On the other hand, unknown receptor status may affect the results.

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