Estimating child mortality associated with maternal mortality from breast and cervical cancer

Abstract

BACKGROUND: Large-scale population studies demonstrate an association between mothers' deaths and child mortality in both lower and higher income countries. The authors estimated children's deaths in association with mothers' deaths from breast or cervical cancer, 2 common cancers in low-income and middle-income countries affecting women of reproductive age, to develop a comprehensive assessment of the death burden of these cancers. METHODS: A Monte Carlo simulation model was devised whereby women were at risk of dying from breast cancer, cervical cancer, or another cause. Compared with children who have living mothers, children of women who die before they reached age 10 years have an elevated risk of death from all causes. Therefore, simulations were conducted, and the impact of mothers' deaths from cervical and breast cancer on associated child mortality was quantified for Bangladesh, Burkina Faso, and Denmark (benchmark analysis), then the analyses were extended to all African countries. RESULTS: Benchmark estimates of child deaths associated with mothers' deaths from breast and cervical cancer resulted in an increment in cancer-related mortality of approximately 2% in Bangladesh, 14% in Burkina Faso, and less than 1% in Denmark. The model predicted an increment in comprehensive cancer deaths when including child death estimates by as high as 30% in certain African countries. CONCLUSIONS: To the authors' knowledge, this is the first study to estimate the impact of a mother's death from cancer on child mortality. The model's estimates call for further investigation into this correlation and underscore the relevance of adequate access to prevention and treatment among women of childbearing age. Cancer 2019;125:109-117.

Maternally Orphaned Children and Intergenerational Concerns Associated With Breast Cancer Deaths Among Women in Sub-Saharan Africa

“…To minimize the intergenerational effects of breast cancer deaths in sub-Saharan Africa, preventing breast cancer deaths through early diagnosis and improved timely treatment should form an essential part of every cancer control plan. [8][9][10] In parallel, support mechanisms are needed for affected families because maternal deaths impact the children's education, 11 development, nutrition, and mortality, 12 as described in a joint report by the United Nations Programme on HIV/AIDS, the United Nations Children's Fund, and the US Agency for International Development. 13 Because women are the cornerstone of many African families, there is often great upheaval after their death.…”

The Breast Health Global Initiative 2018 Global Summit on Improving Breast Healthcare Through Resource‐Stratified Phased Implementation: Methods and overview

“…A recent systematic review reported that investments in women's health had significant beneficial effects on reducing familial poverty, children's mortality rates, and increased economic returns through increased productivity 17,18 . Simulation modeling indicates that maternal death from breast and cervical cancer is associated with an increment in comprehensive cancer deaths when including child death estimates as great as 30% in certain African countries 19 . Thus women's health care affects not only their own lives and productivity but also those of future generations.…”

Gynecological radiation oncology in sub-Saharan Africa: status, problems and considerations for the future

“…Their deaths from potentially avoidable causes contribute to the orphan crisis in an environment with insufficient resources to manage this critical social issue 32. A modeling study defining outcomes of absolute and relative mortality demonstrated that for every 100 women who die from breast and cervical cancer across the African continent, 14–30 children will also die as a direct association 33. The report stated that ‘a child’s risk of death was derived from the baseline country-specific, all cause mortality rate per 100 000 children born multiplied by the excess mortality rate ratio, which is a multiplier of how much higher the rate of dying is for a child whose mother has died compared with a child whose mother is alive in the same population’ 33.…”

“…A modeling study defining outcomes of absolute and relative mortality demonstrated that for every 100 women who die from breast and cervical cancer across the African continent, 14–30 children will also die as a direct association 33. The report stated that ‘a child’s risk of death was derived from the baseline country-specific, all cause mortality rate per 100 000 children born multiplied by the excess mortality rate ratio, which is a multiplier of how much higher the rate of dying is for a child whose mother has died compared with a child whose mother is alive in the same population’ 33. Excess mortality rate is defined as the death rate in the general population due to the excess risk imposed by a specific disease 34.…”