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First Live Births Less Common in Cancer Survivors

GregoryAuneby Gregory Aune, MD, PhD, CKN Editor


Childhood Cancer Survivors have their own unique set of issues that often go unaddressed by health care professionals once treatment has ended and the child enters adulthood.  Although the last 20 years have seen growth in survivorship research, this research is rarely filtered down to the people who need it most – the survivors and their families.  Dr. Gregory Aune, Pediatric Oncologist, researcher, childhood cancer survivor and advocate, has taken on the position of CKN Editor, Knowledge Translation – Childhood Cancer Survivorship.  His goal is simple:  to help empower childhood cancer survivors to start a dialogue with their doctors by publishing short, easy-to-read research study summaries, like this one.


THE HEADLINE: I am a childhood cancer survivor;  Can I have my own biological children?


THE RESEARCH: Journal of Clinical Oncology:  Reproductive Patterns Among Childhood and Adolescent Cancer Survivors in Sweden: A Population-Based Matched-Cohort Study. Researchers in Sweden compared the probability of first live birth in 1,206 survivors of childhood cancers with 2,412 age-matched controls.  Previous studies assessing fertility outcomes in childhood cancer survivors have focused on treatment regimens, as opposed to diagnostic groups and included survivors diagnosed over a wide span of time, some as far back as the 1950’s. A potential limitation of these prior studies was the varied treatments of the survivors which included a wide array of chemotherapy and radiation doses.  Therefore, the primary aim of the Swedish study was to investigate the probability of first live birth in childhood and adolescent cancer survivors in a more contemporary cohort.  An additional aim was to evaluate findings with respect to disease group, rather than by treatment exposures.


KEY FINDINGS:  The probability of a first live birth (compared to age-matched controls), was significantly lower in both male and female survivors.  In women, those survivors diagnosed in adolescence (age 14-21) had no decrease in probability, while those diagnosed during childhood (<14) had a significantly lower probability of a first live birth.  In men, the findings were opposite, with survivors diagnosed during adolescence less likely to have a first live birth than those diagnosed during childhood.  Overall, male survivors had a lower probability of first live birth than females.  Among diagnostic groups, survivors of CNS tumors, mesothelial, and soft tissue tumors had the lowest probability of first live birth.  Interestingly, survivors treated for cancers of the urinary tract and male genitals had no reduction in the probability of first live birth when compared to age-matched controls.


WHAT THIS MEANS FOR CHILDHOOD CANCER SURVIVORS: Questions and concerns regarding potential fertility are prevalent among childhood cancer survivors and their families. This study documents decreased probability of a first live birth in a contemporary cohort of childhood and adolescent cancer survivors in Sweden. It is important to stress that in this study there were significant rates of successful pregnancies – for male survivors, 39% were linked to at least one live birth. For female survivors, 50% gave birth to at least one live child after their cancer diagnosis. Thus, survivors should have a positive outlook regarding their potential to have biological children, especially with the emerging efforts to preserve fertility and to decrease exposures to the most gonadotoxic treatments. These findings further highlight the need to have thoughtful discussions on fertility preservation at the time of diagnosis and for the ongoing monitoring of reproductive health in the long-term follow-up setting. All survivors should have a discussion with their doctors regarding their individual reproductive potential at the point in their lives when this becomes most relevant.



Medical Disclaimer:  The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only.  If you feel the research summarized applies to you or someone you know, talk to your doctor about your concerns.



Videos with Dr. Aune

Presentation on YouTube (Jan 2015):  Eliminating Long-term Health Effects in Cancer Survivors – Gregory Aune, MD, PhD

Interview for the National Coalition for Cancer Survivorship (June 2015):  Hodgkin’s Lymphoma Survivor Dr. Greg Aune Discusses Issues in Long-Term Survivorship Care

Interview with the Washington Post Live Summit (Dec 2016): How cancer lives on in young adults after treatment ends



Dr. Gregory J. Aune is the Stephanie Edlund Distinguished Professor of Pediatric Cancer Research and a St. Baldrick’s Foundation Scholar.  His experience in pediatric cancer spans over 27 years and encompasses his own patient experiences, research in experimental therapeutics, clinical care of pediatric oncology patients, and childhood cancer advocacy.  His interest in pediatric oncology began at age 16, when he was diagnosed with Hodgkin’s lymphoma.  While fortunate to survive, the experiences he encountered as a patient initiated a path towards a research and clinical career aimed at developing less toxic chemotherapy regimens.  His experience as a long-term survivor included open-heart surgery at age 35 to replace his aortic valve and bypass three blocked coronary arteries that were damaged by his teenage cancer therapies.  This life-changing event initiated his research interest in cardiac disease.  His training to become a successful physician scientist and pediatric oncologist has included time spent at some of the most well-respected oncology institutions in the United States including, M.D. Anderson Cancer Center, the National Cancer Institute, and Johns Hopkins Hospital.

Dr. Aune is a national leader in childhood cancer advocacy efforts.  In San Antonio, he has been a leader in local fundraising and awareness efforts.   Since 2010, he has spearheaded efforts by the St. Baldrick’s Foundation and For the Kids Dance Marathon at the University of Texas San Antonio that have raised over $830,000 for childhood cancer patients and research efforts.  In September 2014, his appointment to the National Cancer Institute Council of Research Advocates (NCRA) was announced by NCI Director Dr. Harold Varmus at a White House briefing on childhood cancer.

In addition, Dr. Aune is a policy advisor for the National Coalition for Cancer Survivorship, serves on the Board of Directors of the American Childhood Cancer Organization, is a member of the St. Baldrick’s Foundation National Advocacy Committee, and serves on the scientific advisory board for the Canines-N-Kids foundation.

In May 2015, Dr. Aune addressed the 68th World Health Assembly in Geneva, Switzerland and called on the World Health Organization to make childhood cancer a top global health priority.



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