image_pdfimage_print

Is it safe for women to get pregnant after breast cancer treatment

Pregnancy after breast cancer treatment

Pregnancy after breast cancer treatment

After treatment of breast cancer to the satisfaction of her oncologist, should a woman who desire to get pregnant be discouraged from doing so? A very critical question considering the fact that there are close to half a million breast cancer survivors living in the US and are in the childbearing age.

Is it safe for women to get pregnant after breast cancer treatment?

For a very long time, counseling of women regarding pregnancy was dependent on the fact that estrogen increases during pregnancy and because estrogen has some effects on both estrogen receptor positive and estrogen receptor negative breast cancers, its probably better if women avoid pregnancy-unless of course another woman is carrying for them, a gestational carrier. This recommendation is not based on strong scientific evidence.

Safety of pregnancy after breast cancer treatment. All the published reports included a total of 1417 women who got pregnant after breast cancer treatment and 18059 who survived breast cancer and did not get pregnant. Women who got pregnant following breast cancer diagnosis had significantly better survival compared to women who did not get pregnant. In fact, those who got pregnant were more than 40% less likely to die because of breast cancer.

Pregnancy after breast cancer treatment

Pregnancy after breast cancer treatment

Important caveat to these studies is the healthy mother bias-the tendency of healthier women to desire and attempt pregnancy and the less healthy women to avoid pregnancy. This may inflate the safety of becoming pregnant after breast cancer treatment. Studies also largely did not address the chance for recurrence. Nevertheless, no study showed detrimental effect in breast cancer survivors who become pregnant. The largest of these studies published by The Danish Breast Cancer Cooperative Group was a population based study and included over 10,000 women who survived breast cancer and were under the age of 45. Three hundreds and sixty-seventy one women experienced 465 pregnancies and 236 deliveries. Women who got pregnant-full term or spontaneous miscarriage, were at least 30% less likely to die from breast cancer. Women with low risk breast cancers enjoyed 45% higher chance for survival after full term pregnancy than similar women who did not get pregnant.

How long should women wait after breast cancer treatment before attempting pregnancy? The majority of experts recommend waiting for about two years as the majority of recurrences takes place within this period. There are differences in recurrence pattern, however, between estrogen receptor negative and estrogen receptor positive tumors. Estrogen receptor negative tumors are more common in younger women and tend to recur earlier-within 2years after treatment. Recurrence of estrogen receptor positive cancers remain as high as 4-5% per year for about 15 years.

Pregnancy in BRCA1 and BRCA2 mutation carriers. In BRCA1 pregnancy does not seem to increase the risk of early onset breast cancer. In BRCA2 carriers, pregnancy may cause a borderline increase in risk of breast cancer before 50, especially when first pregnancy after age 40.

Pregnancy after breast cancer treatment

Pregnancy after breast cancer treatment

Breast feeding is recommended whenever possible in women treated for breast cancer, even if they are BRCA carriers and does not appear to impact breast cancer prognosis and may even be protective in some cases.

Contraception. If pregnancy is not desired as during breast cancer treatment and the follow up period after treatment non hormonal contraception is recommended such as IUD or barrier method e.g. condom. BRCA1 carriers may show an increased risk for early onset breast cancer if they use oral contraceptive pills before the age of 30 or for more than 5 years.

Young women diagnosed with breast cancer are commonly very concerned about their future fertility and safety of pregnancy after treatment. Proper counseling enables them to make appropriate decisions about future reproduction and fertility preservation. At the end of the day, most of the breast cancer battles will be won, some will be lost, pregnancy does not appear to contribute to that loss.


Facebooktwittergoogle_pluspinterestlinkedinmailFacebooktwittergoogle_pluspinterestlinkedinmail
Fertility in Women Carrying BRCA Gene Abnormality

Fertility in Women Carrying BRCA Gene Abnormality

Fertility in women carrying BRCA gene abnormality may be reduced

Women carrying BRCA gene abnormality frequently consult with reproductive endocrinologists for fertility treatment or preservation.  Women referred to test the BRCA gene for mutations based on ancestry, family history and type of cancer diagnosed in her family. If a mutation is found the lifetime risk for breast cancer is 70% and ovary cancer is 40%.

Fertility in women with BRCA mutations maybe reduced in reproductive age women because of the mutation itself, procedures used to reduce the risk of cancer or cancer treatment if they develop cancer.

 

BRCA mutation and Fertility

BRCA mutation and Fertility

Ovarian Reserve and Response to Ovarian Stimulation

Women carrying a BRCA mutation may require ovarian stimulation using fertility medications for

  1. Preservation of fertility through egg freezing or embryo freezing prior to prophylactic removal of both ovaries,
  2. Preservation of fertility after the diagnosis of breast cancer and before chemotherapy or
  3. An incidental fertility problem unrelated to BRCA mutation.

Ovarian reserve and response to fertility medication is one of the most determinants of success of fertility treatment or preservation.

Although it was suggested that women with BRCA mutations respond more modestly to fertility medications, this was not proven. When women carrying these mutations were compared to relatives with no mutations, there were no differences in the number of deliveries and the need for fertility treatment. Also in a study of 260 Ashkenazi Jewish women with ovarian cancer and 331 controls, unselected for age or family history of the disease. Pregnancy success was similar for 96 mutation carrier and 164 non-carrier cases and controls.

Fertility & fertility treatment

Its unlikely that fertility or fertility treatment will increase the risk for breast cancer in women with BRCA mutations. 1380 women diagnosed with breast cancer and carrying BRCA mutations were matched 1380 women without breast cancer and carrying BRCA mutations. 16% reported fertility problems, 4% used fertility medications and 1% used IVF. There was no difference between women who developed breast cancer and those who did not regarding history of infertility and the use of fertility medication. The type of fertility medicine-oral or injection medication also did not change the risk for breast cancer, irrespective if women had children before or not.

Interestingly, there is significant excess of females among the offspring of female carriers of BRCA1 and BRCA2 mutations-higher female to male ratio.

Avoiding BRCA transmission to babies (PGD)

Women interested in getting pregnant should be counseled to the risk of transmission of mutation to future children. Both men and women carrying the mutation are at a significantly increased risk of cancer. It is very possible to prevent this transmission if the eggs or embryos are tested before replacement into the uterus in women undergoing in vitro fertilization – IVF Eggs are tested by polar body biopsy (this is a small cell attached to the egg and carry chromosomes representative to those of the egg). Embryos are tested by testing one cell of a 6 to 8 cell embryo. Testing has many medical and ethical dimensions and is better handled by providers specializing in these areas.

Pregnancy

The risk of breast cancer may increase with multiple pregnancies and deliveries in women carrying BRCA2 mutations. In BRCA1 mutation carriers, late menarche and breast feeding reduces the risk for breast cancer. The effect of pregnancy on cancer risk though was not confirmed in multiple studies.

Read more to learn about different methods for preserving fertility after BRCA diagnosis.

Facebooktwittergoogle_pluspinterestlinkedinmailFacebooktwittergoogle_pluspinterestlinkedinmail