CAnceR IN PreGnancy (CARING) – a retrospective study of cancer diagnosed during pregnancy in the United Kingdom
Background The incidence of cancer diagnosed during pregnancy is increasing. Data relating to investigation and management, as well as maternal and foetal outcomes is lacking in a United Kingdom (UK) population. Methods In this retrospective study we report data from 119 patients diagnosed with canc...
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Veröffentlicht in: | British journal of cancer 2024-05, Vol.130 (8), p.1261-1268 |
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creator | Baxter, M. A. Denholm, M. Kingdon, S. J. Kathirgamakarthigeyan, S. Parikh, S. Shakir, R. Johnson, R. Martin, H. Walton, M. Yao, W. Swan, A. Samuelson, C. Ren, X. Cooper, A. Gray, H-L Clifton, S. Ball, J. Gullick, G. Anderson, M. Dodd, L. Hayhurst, H. Salama, M. Shotton, R. Britton, F. Christodoulou, T. Abdul-Hamid, A. Eichholz, A. Evans, R. M. Wallroth, P. Gibson, F. Poole, K. Rowe, M. Harris, J. |
description | Background
The incidence of cancer diagnosed during pregnancy is increasing. Data relating to investigation and management, as well as maternal and foetal outcomes is lacking in a United Kingdom (UK) population.
Methods
In this retrospective study we report data from 119 patients diagnosed with cancer during pregnancy from 14 cancer centres in the UK across a five-year period (2016-2020).
Results
Median age at diagnosis was 33 years, with breast, skin and haematological the most common primary sites. The majority of cases were new diagnoses (109 patients, 91.6%). Most patients were treated with radical intent (96 patients, 80.7%), however, gastrointestinal cancers were associated with a high rate of palliative intent treatment (63.6%). Intervention was commenced during pregnancy in 68 (57.1%) patients; 44 (37%) had surgery and 31 (26.1%) received chemotherapy. Live births occurred in 98 (81.7%) of the cases, with 54 (55.1%) of these delivered by caesarean section. Maternal mortality during the study period was 20.2%.
Conclusions
This is the first pan-tumour report of diagnosis, management and outcomes of cancer diagnosed during pregnancy in the UK. Our findings demonstrate proof of concept that data collection is feasible and highlight the need for further research in this cohort of patients. |
doi_str_mv | 10.1038/s41416-024-02605-x |
format | Article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11014900</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3037673904</sourcerecordid><originalsourceid>FETCH-LOGICAL-c426t-f9ca58bca58e718db484eb00f5d44e82c61683fd9bee6d35272dbfee0d6c11583</originalsourceid><addsrcrecordid>eNp9kc9u1DAQxi0EokvhBTggS1zKIXT8J4lzQqsVbFdUBVX0bCX2ZJtq107tpOreeAfekCfB25RSOCDLHlnzm8-e-Qh5zeA9A6GOo2SSFRlwmXYBeXb7hMxYLnjGFC-fkhkAlBlUHA7Iixiv0rUCVT4nB0KlVYKckevF3Bk8p6sz-jXg0tXO7OjRYn6-Olu-oz-__6A1DTgEH3s0Q3eDNA6j3VHfUpNYDNR29dr5iJbaMXRuTfuA60mnc3S4RHrhuiGlP6ek9duX5FlbbyK-uo-H5OLTx2-Lk-z0y3K1mJ9mRvJiyNrK1Llq9geWTNlGKokNQJtbKVFxU7BCidZWDWJhRc5LbpsWEWxhGMuVOCQfJt1-bLZoDboh1Bvdh25bh532daf_zrjuUq_9jWYMmKwAksLRvULw1yPGQW-7aHCzqR36MWpeCZClyBlL6Nt_0Cs_Bpf60wJEWZSiApkoPlEmzTMGbB9-w0DvLdWTpTpZqu8s1bep6M3jPh5KfnuYADEBsd_PH8Oft_8j-wslJK4f</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3037673904</pqid></control><display><type>article</type><title>CAnceR IN PreGnancy (CARING) – a retrospective study of cancer diagnosed during pregnancy in the United Kingdom</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Baxter, M. A. ; Denholm, M. ; Kingdon, S. J. ; Kathirgamakarthigeyan, S. ; Parikh, S. ; Shakir, R. ; Johnson, R. ; Martin, H. ; Walton, M. ; Yao, W. ; Swan, A. ; Samuelson, C. ; Ren, X. ; Cooper, A. ; Gray, H-L ; Clifton, S. ; Ball, J. ; Gullick, G. ; Anderson, M. ; Dodd, L. ; Hayhurst, H. ; Salama, M. ; Shotton, R. ; Britton, F. ; Christodoulou, T. ; Abdul-Hamid, A. ; Eichholz, A. ; Evans, R. M. ; Wallroth, P. ; Gibson, F. ; Poole, K. ; Rowe, M. ; Harris, J.</creator><creatorcontrib>Baxter, M. A. ; Denholm, M. ; Kingdon, S. J. ; Kathirgamakarthigeyan, S. ; Parikh, S. ; Shakir, R. ; Johnson, R. ; Martin, H. ; Walton, M. ; Yao, W. ; Swan, A. ; Samuelson, C. ; Ren, X. ; Cooper, A. ; Gray, H-L ; Clifton, S. ; Ball, J. ; Gullick, G. ; Anderson, M. ; Dodd, L. ; Hayhurst, H. ; Salama, M. ; Shotton, R. ; Britton, F. ; Christodoulou, T. ; Abdul-Hamid, A. ; Eichholz, A. ; Evans, R. M. ; Wallroth, P. ; Gibson, F. ; Poole, K. ; Rowe, M. ; Harris, J. ; National Oncology Trainees Collaborative for Healthcare Research (NOTCH)</creatorcontrib><description>Background
The incidence of cancer diagnosed during pregnancy is increasing. Data relating to investigation and management, as well as maternal and foetal outcomes is lacking in a United Kingdom (UK) population.
Methods
In this retrospective study we report data from 119 patients diagnosed with cancer during pregnancy from 14 cancer centres in the UK across a five-year period (2016-2020).
Results
Median age at diagnosis was 33 years, with breast, skin and haematological the most common primary sites. The majority of cases were new diagnoses (109 patients, 91.6%). Most patients were treated with radical intent (96 patients, 80.7%), however, gastrointestinal cancers were associated with a high rate of palliative intent treatment (63.6%). Intervention was commenced during pregnancy in 68 (57.1%) patients; 44 (37%) had surgery and 31 (26.1%) received chemotherapy. Live births occurred in 98 (81.7%) of the cases, with 54 (55.1%) of these delivered by caesarean section. Maternal mortality during the study period was 20.2%.
Conclusions
This is the first pan-tumour report of diagnosis, management and outcomes of cancer diagnosed during pregnancy in the UK. Our findings demonstrate proof of concept that data collection is feasible and highlight the need for further research in this cohort of patients.</description><identifier>ISSN: 0007-0920</identifier><identifier>ISSN: 1532-1827</identifier><identifier>EISSN: 1532-1827</identifier><identifier>DOI: 10.1038/s41416-024-02605-x</identifier><identifier>PMID: 38383704</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>631/67/2324 ; 692/308/174 ; 692/4028/67/2324 ; 692/699/67/2324 ; Biomedical and Life Sciences ; Biomedicine ; Cancer ; Cancer Research ; Cesarean Section ; Chemotherapy ; Data collection ; Diagnosis ; Drug Resistance ; Epidemiology ; Female ; Humans ; Live Birth ; Molecular Medicine ; Neoplasms - diagnosis ; Neoplasms - epidemiology ; Neoplasms - therapy ; Oncology ; Patients ; Pregnancy ; Retrospective Studies ; United Kingdom - epidemiology</subject><ispartof>British journal of cancer, 2024-05, Vol.130 (8), p.1261-1268</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c426t-f9ca58bca58e718db484eb00f5d44e82c61683fd9bee6d35272dbfee0d6c11583</cites><orcidid>0000-0002-5773-8650 ; 0000-0001-8993-0148</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/s41416-024-02605-x$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/s41416-024-02605-x$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38383704$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baxter, M. A.</creatorcontrib><creatorcontrib>Denholm, M.</creatorcontrib><creatorcontrib>Kingdon, S. J.</creatorcontrib><creatorcontrib>Kathirgamakarthigeyan, S.</creatorcontrib><creatorcontrib>Parikh, S.</creatorcontrib><creatorcontrib>Shakir, R.</creatorcontrib><creatorcontrib>Johnson, R.</creatorcontrib><creatorcontrib>Martin, H.</creatorcontrib><creatorcontrib>Walton, M.</creatorcontrib><creatorcontrib>Yao, W.</creatorcontrib><creatorcontrib>Swan, A.</creatorcontrib><creatorcontrib>Samuelson, C.</creatorcontrib><creatorcontrib>Ren, X.</creatorcontrib><creatorcontrib>Cooper, A.</creatorcontrib><creatorcontrib>Gray, H-L</creatorcontrib><creatorcontrib>Clifton, S.</creatorcontrib><creatorcontrib>Ball, J.</creatorcontrib><creatorcontrib>Gullick, G.</creatorcontrib><creatorcontrib>Anderson, M.</creatorcontrib><creatorcontrib>Dodd, L.</creatorcontrib><creatorcontrib>Hayhurst, H.</creatorcontrib><creatorcontrib>Salama, M.</creatorcontrib><creatorcontrib>Shotton, R.</creatorcontrib><creatorcontrib>Britton, F.</creatorcontrib><creatorcontrib>Christodoulou, T.</creatorcontrib><creatorcontrib>Abdul-Hamid, A.</creatorcontrib><creatorcontrib>Eichholz, A.</creatorcontrib><creatorcontrib>Evans, R. M.</creatorcontrib><creatorcontrib>Wallroth, P.</creatorcontrib><creatorcontrib>Gibson, F.</creatorcontrib><creatorcontrib>Poole, K.</creatorcontrib><creatorcontrib>Rowe, M.</creatorcontrib><creatorcontrib>Harris, J.</creatorcontrib><creatorcontrib>National Oncology Trainees Collaborative for Healthcare Research (NOTCH)</creatorcontrib><title>CAnceR IN PreGnancy (CARING) – a retrospective study of cancer diagnosed during pregnancy in the United Kingdom</title><title>British journal of cancer</title><addtitle>Br J Cancer</addtitle><addtitle>Br J Cancer</addtitle><description>Background
The incidence of cancer diagnosed during pregnancy is increasing. Data relating to investigation and management, as well as maternal and foetal outcomes is lacking in a United Kingdom (UK) population.
Methods
In this retrospective study we report data from 119 patients diagnosed with cancer during pregnancy from 14 cancer centres in the UK across a five-year period (2016-2020).
Results
Median age at diagnosis was 33 years, with breast, skin and haematological the most common primary sites. The majority of cases were new diagnoses (109 patients, 91.6%). Most patients were treated with radical intent (96 patients, 80.7%), however, gastrointestinal cancers were associated with a high rate of palliative intent treatment (63.6%). Intervention was commenced during pregnancy in 68 (57.1%) patients; 44 (37%) had surgery and 31 (26.1%) received chemotherapy. Live births occurred in 98 (81.7%) of the cases, with 54 (55.1%) of these delivered by caesarean section. Maternal mortality during the study period was 20.2%.
Conclusions
This is the first pan-tumour report of diagnosis, management and outcomes of cancer diagnosed during pregnancy in the UK. Our findings demonstrate proof of concept that data collection is feasible and highlight the need for further research in this cohort of patients.</description><subject>631/67/2324</subject><subject>692/308/174</subject><subject>692/4028/67/2324</subject><subject>692/699/67/2324</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Cancer</subject><subject>Cancer Research</subject><subject>Cesarean Section</subject><subject>Chemotherapy</subject><subject>Data collection</subject><subject>Diagnosis</subject><subject>Drug Resistance</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Humans</subject><subject>Live Birth</subject><subject>Molecular Medicine</subject><subject>Neoplasms - diagnosis</subject><subject>Neoplasms - epidemiology</subject><subject>Neoplasms - therapy</subject><subject>Oncology</subject><subject>Patients</subject><subject>Pregnancy</subject><subject>Retrospective Studies</subject><subject>United Kingdom - epidemiology</subject><issn>0007-0920</issn><issn>1532-1827</issn><issn>1532-1827</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9kc9u1DAQxi0EokvhBTggS1zKIXT8J4lzQqsVbFdUBVX0bCX2ZJtq107tpOreeAfekCfB25RSOCDLHlnzm8-e-Qh5zeA9A6GOo2SSFRlwmXYBeXb7hMxYLnjGFC-fkhkAlBlUHA7Iixiv0rUCVT4nB0KlVYKckevF3Bk8p6sz-jXg0tXO7OjRYn6-Olu-oz-__6A1DTgEH3s0Q3eDNA6j3VHfUpNYDNR29dr5iJbaMXRuTfuA60mnc3S4RHrhuiGlP6ek9duX5FlbbyK-uo-H5OLTx2-Lk-z0y3K1mJ9mRvJiyNrK1Llq9geWTNlGKokNQJtbKVFxU7BCidZWDWJhRc5LbpsWEWxhGMuVOCQfJt1-bLZoDboh1Bvdh25bh532daf_zrjuUq_9jWYMmKwAksLRvULw1yPGQW-7aHCzqR36MWpeCZClyBlL6Nt_0Cs_Bpf60wJEWZSiApkoPlEmzTMGbB9-w0DvLdWTpTpZqu8s1bep6M3jPh5KfnuYADEBsd_PH8Oft_8j-wslJK4f</recordid><startdate>20240503</startdate><enddate>20240503</enddate><creator>Baxter, M. A.</creator><creator>Denholm, M.</creator><creator>Kingdon, S. J.</creator><creator>Kathirgamakarthigeyan, S.</creator><creator>Parikh, S.</creator><creator>Shakir, R.</creator><creator>Johnson, R.</creator><creator>Martin, H.</creator><creator>Walton, M.</creator><creator>Yao, W.</creator><creator>Swan, A.</creator><creator>Samuelson, C.</creator><creator>Ren, X.</creator><creator>Cooper, A.</creator><creator>Gray, H-L</creator><creator>Clifton, S.</creator><creator>Ball, J.</creator><creator>Gullick, G.</creator><creator>Anderson, M.</creator><creator>Dodd, L.</creator><creator>Hayhurst, H.</creator><creator>Salama, M.</creator><creator>Shotton, R.</creator><creator>Britton, F.</creator><creator>Christodoulou, T.</creator><creator>Abdul-Hamid, A.</creator><creator>Eichholz, A.</creator><creator>Evans, R. M.</creator><creator>Wallroth, P.</creator><creator>Gibson, F.</creator><creator>Poole, K.</creator><creator>Rowe, M.</creator><creator>Harris, J.</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TO</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5773-8650</orcidid><orcidid>https://orcid.org/0000-0001-8993-0148</orcidid></search><sort><creationdate>20240503</creationdate><title>CAnceR IN PreGnancy (CARING) – a retrospective study of cancer diagnosed during pregnancy in the United Kingdom</title><author>Baxter, M. A. ; Denholm, M. ; Kingdon, S. J. ; Kathirgamakarthigeyan, S. ; Parikh, S. ; Shakir, R. ; Johnson, R. ; Martin, H. ; Walton, M. ; Yao, W. ; Swan, A. ; Samuelson, C. ; Ren, X. ; Cooper, A. ; Gray, H-L ; Clifton, S. ; Ball, J. ; Gullick, G. ; Anderson, M. ; Dodd, L. ; Hayhurst, H. ; Salama, M. ; Shotton, R. ; Britton, F. ; Christodoulou, T. ; Abdul-Hamid, A. ; Eichholz, A. ; Evans, R. M. ; Wallroth, P. ; Gibson, F. ; Poole, K. ; Rowe, M. ; Harris, J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c426t-f9ca58bca58e718db484eb00f5d44e82c61683fd9bee6d35272dbfee0d6c11583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>631/67/2324</topic><topic>692/308/174</topic><topic>692/4028/67/2324</topic><topic>692/699/67/2324</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Cancer</topic><topic>Cancer Research</topic><topic>Cesarean Section</topic><topic>Chemotherapy</topic><topic>Data collection</topic><topic>Diagnosis</topic><topic>Drug Resistance</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Humans</topic><topic>Live Birth</topic><topic>Molecular Medicine</topic><topic>Neoplasms - diagnosis</topic><topic>Neoplasms - epidemiology</topic><topic>Neoplasms - therapy</topic><topic>Oncology</topic><topic>Patients</topic><topic>Pregnancy</topic><topic>Retrospective Studies</topic><topic>United Kingdom - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baxter, M. A.</creatorcontrib><creatorcontrib>Denholm, M.</creatorcontrib><creatorcontrib>Kingdon, S. 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M.</creatorcontrib><creatorcontrib>Wallroth, P.</creatorcontrib><creatorcontrib>Gibson, F.</creatorcontrib><creatorcontrib>Poole, K.</creatorcontrib><creatorcontrib>Rowe, M.</creatorcontrib><creatorcontrib>Harris, J.</creatorcontrib><creatorcontrib>National Oncology Trainees Collaborative for Healthcare Research (NOTCH)</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baxter, M. A.</au><au>Denholm, M.</au><au>Kingdon, S. J.</au><au>Kathirgamakarthigeyan, S.</au><au>Parikh, S.</au><au>Shakir, R.</au><au>Johnson, R.</au><au>Martin, H.</au><au>Walton, M.</au><au>Yao, W.</au><au>Swan, A.</au><au>Samuelson, C.</au><au>Ren, X.</au><au>Cooper, A.</au><au>Gray, H-L</au><au>Clifton, S.</au><au>Ball, J.</au><au>Gullick, G.</au><au>Anderson, M.</au><au>Dodd, L.</au><au>Hayhurst, H.</au><au>Salama, M.</au><au>Shotton, R.</au><au>Britton, F.</au><au>Christodoulou, T.</au><au>Abdul-Hamid, A.</au><au>Eichholz, A.</au><au>Evans, R. M.</au><au>Wallroth, P.</au><au>Gibson, F.</au><au>Poole, K.</au><au>Rowe, M.</au><au>Harris, J.</au><aucorp>National Oncology Trainees Collaborative for Healthcare Research (NOTCH)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>CAnceR IN PreGnancy (CARING) – a retrospective study of cancer diagnosed during pregnancy in the United Kingdom</atitle><jtitle>British journal of cancer</jtitle><stitle>Br J Cancer</stitle><addtitle>Br J Cancer</addtitle><date>2024-05-03</date><risdate>2024</risdate><volume>130</volume><issue>8</issue><spage>1261</spage><epage>1268</epage><pages>1261-1268</pages><issn>0007-0920</issn><issn>1532-1827</issn><eissn>1532-1827</eissn><abstract>Background
The incidence of cancer diagnosed during pregnancy is increasing. Data relating to investigation and management, as well as maternal and foetal outcomes is lacking in a United Kingdom (UK) population.
Methods
In this retrospective study we report data from 119 patients diagnosed with cancer during pregnancy from 14 cancer centres in the UK across a five-year period (2016-2020).
Results
Median age at diagnosis was 33 years, with breast, skin and haematological the most common primary sites. The majority of cases were new diagnoses (109 patients, 91.6%). Most patients were treated with radical intent (96 patients, 80.7%), however, gastrointestinal cancers were associated with a high rate of palliative intent treatment (63.6%). Intervention was commenced during pregnancy in 68 (57.1%) patients; 44 (37%) had surgery and 31 (26.1%) received chemotherapy. Live births occurred in 98 (81.7%) of the cases, with 54 (55.1%) of these delivered by caesarean section. Maternal mortality during the study period was 20.2%.
Conclusions
This is the first pan-tumour report of diagnosis, management and outcomes of cancer diagnosed during pregnancy in the UK. Our findings demonstrate proof of concept that data collection is feasible and highlight the need for further research in this cohort of patients.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>38383704</pmid><doi>10.1038/s41416-024-02605-x</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-5773-8650</orcidid><orcidid>https://orcid.org/0000-0001-8993-0148</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | 631/67/2324 692/308/174 692/4028/67/2324 692/699/67/2324 Biomedical and Life Sciences Biomedicine Cancer Cancer Research Cesarean Section Chemotherapy Data collection Diagnosis Drug Resistance Epidemiology Female Humans Live Birth Molecular Medicine Neoplasms - diagnosis Neoplasms - epidemiology Neoplasms - therapy Oncology Patients Pregnancy Retrospective Studies United Kingdom - epidemiology |
title | CAnceR IN PreGnancy (CARING) – a retrospective study of cancer diagnosed during pregnancy in the United Kingdom |
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