Childbearing History Associated With Improved Survival in Choroidal Melanoma

Abstract

Background: Research in cutaneous melanoma suggests that women may experience better tumordependent survival than men, and some studies have shown that the advantange is specific to childbearing. Objective: To examine whether childbearing may be a favorable prognostic factor in melanoma of the uveal tract.

Hormonal exposures and the risk of uveal melanoma

“…'Confirmed' PCB oil indicates that a brand name with known PCB content (such as Phenoclor, Pyralene, or Clophen) was reported n/e not estimable effect was detected for women who had undergone bilateral oophorectomy or who took menopausal estrogens [7]. An increasing number of births also conferred a rather protective effect on the risk of death from metastatic uveal melanoma [20]. However, our results are in contrast to another case-control study from the United States (n = 237 female cases) which found increased uveal melanoma risks for women who had ever been pregnant, women with intact ovaries, women with liver cirrhosis, and women taking menopausal HRT [6].…”

Disparities in Uveal Melanoma: Patient Characteristics

“…They found that both female gender and history of having given birth were protective factors with respect to death secondary to metastasis, most notably in the early years (<3y) after diagnosis. 23 Specifically, they found that nulliparous women and men were at comparably increased risk of metastasis and death relative to parous women. Of interest, the number of children birthed had a dose-related protective impact, as did the number of years since first giving birth.…”

“…Of interest, the number of children birthed had a dose-related protective impact, as did the number of years since first giving birth. 23 Schmidt-Pokrzywniak et al investigated the impact of childbearing on five-year survival in a cohort of 459 women in Germany. In their study, the investigators found women to have lower five-year probability of death secondary to uveal melanoma (10.9% vs. 6.2%), even after accounting for the impact of prognostic factors such as ciliary body involvement and tumor basal diameter.…”

“…24 Both Egan and Schmidt-Pokrzywniak hypothesize that parous women may, in fact, benefit from an immunizing effect secondary to exposure to fetal antigens during pregnancy, which prove beneficial in the immune response to uveal melanoma. This expands on what Janerich refers to as the “fetal antigen hypothesis.” 23–25 The “fetal antigen hypothesis” was first put forth as a potential explanation for the “crossover” phenomenon in which parous women are paradoxically at increased risk of breast cancer soon after giving birth, but are, in the aggregate, at lower risk of developing the disease in the long term, presumably due to increased immune surveillance in the wake of fetal antigen exposure during pregnancy. 25 …”

Assessment of the effect of iris colour and having children on 5-year risk of death after diagnosis of uveal melanoma: a follow-up study

“…The protective influence of parity was strongest in the early period following diagnosis and treatment. The level of protection increased with the number of live births [15]. …”