1
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Abraham M, Lak MA, Gurz D, Nolasco FOM, Kondraju PK, Iqbal J. A Narrative Review of Breastfeeding and Its Correlation With Breast Cancer: Current Understanding and Outcomes. Cureus 2023; 15:e44081. [PMID: 37750138 PMCID: PMC10518059 DOI: 10.7759/cureus.44081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
Breastfeeding has been extensively studied in relation to breast cancer risk. The results of the reviewed studies consistently show a decreased risk of breast cancer associated with breastfeeding, especially for 12 months or longer. This protective effect is attributed to hormonal, immunological, and physiological changes during lactation. Breastfeeding also appears to have a greater impact on reducing breast cancer risk in premenopausal women and specific breast cancer subtypes. Encouraging breastfeeding has dual benefits: benefiting infants and reducing breast cancer risk long-term. Healthcare professionals should provide evidence-based guidance on breastfeeding initiation, duration, and exclusivity, while public health policies should support breastfeeding by creating enabling environments. This review examines the existing literature and analyzes the correlation between breastfeeding and breast cancer risk.
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Affiliation(s)
- Merin Abraham
- Department of Internal Medicine, Kasturba Medical College, Manipal, IND
| | - Muhammad Ali Lak
- Department of Internal Medicine, Combined Military Hospital, Lahore, PAK
| | - Danyel Gurz
- Department of Internal Medicine, Combined Military Hospital, Lahore, PAK
| | | | | | - Javed Iqbal
- Department of Neurosurgery, Mayo Hospital, Lahore, PAK
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2
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Di Mattei VE, Perego G, Taranto P, Mazzetti M, Ferrari F, Derna N, Peccatori FA, Mangili G, Candiani M. Psychological issues in breast cancer survivors confronted with motherhood: Literature review and a call to action. Front Psychol 2023; 14:1133204. [PMID: 36960007 PMCID: PMC10029924 DOI: 10.3389/fpsyg.2023.1133204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Breast cancer is currently the most common cancer among women worldwide; in 15-25% of cases, patients are premenopausal at the time of diagnosis, and 50% of women desire pregnancy after cancer diagnosis. Motherhood after breast cancer involves complex psychological challenges with long-term consequences, though it is safely pursuable with adequate support. The purpose of this mini-review is to analyze the psychological implications surrounding pregnancy and motherhood after breast cancer and promote action in addressing the challenges that might affect women facing these life events.
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Affiliation(s)
- Valentina Elisabetta Di Mattei
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gaia Perego
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Taranto
- Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Mazzetti
- Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Noemi Derna
- Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fedro Alessandro Peccatori
- Fertility and Procreation Unit, Division of Gynecologic Oncology, Department of Gynecology, European Institute of Oncology IRCCS, Milan, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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3
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Futamura M, Yoshida K. Current status of AYA-generation breast cancer: trends worldwide and in Japan. Int J Clin Oncol 2021; 27:16-24. [PMID: 34921319 DOI: 10.1007/s10147-021-02087-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022]
Abstract
Breast cancer (BC) is the most common cancer worldwide among women. In Japan, the incidence of BC gradually increased. The recent number of adolescent and young adult (AYA)-BC patients is approximately 4,000-5,000 every year, accounting for 5% of all BC cases. BC in young people has been attracting attention since Japan's third basic plan to promote cancer control programs incorporated cancer control measures for pediatric (age ≤ 14 years) and adolescent and young adult (AYA)-generation (age 15-39 years) cancers in 2018. Attention is needed to detect AYA-BC because of the presence of dense breasts. AYA-BC patients are clinically characterized by larger tumor size, more lymph node metastases, advanced stages, and a higher rate of aggressive phenotypes, such as triple-negative or HER2-positive subtypes, and are strongly associated with family history and genetic germline alterations, including hereditary breast and ovarian cancers. Given that AYA-BC patients show a poorer prognosis than older BC patients, they often require intensive therapies, including surgery, radiation, chemotherapy, and endocrine therapy. We must solve many survivorship-associated problems in AYA-BC patients, including fertility preservation, comorbidity after treatment, and long-term follow-up. Under these circumstances, national and local governments and various academic societies have started addressing these problems by formulating laws and guidelines, establishing medical systems, and offering financial support to conquer cancer and maintain a better quality of life. This review summarizes the current trends of AYA-BC worldwide and in Japan. Further Japan-specific data on AYA-BC are required to clarify its characteristics and improve prognosis and survivorship.
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Affiliation(s)
- Manabu Futamura
- Breast Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Kazuhiro Yoshida
- Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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4
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Smorti M, Testa I, Gallese M, Dotti A, Ionio C, Andreol A, Zilioli A, Pravettoni G, Greco A, Fenaroli V, Nastasi G, Giuntini N, Bonassi L. Protect, promote and support: a warm chain of breastfeeding for oncological women-results from a survey of young Italian cancer mothers. Ecancermedicalscience 2020; 14:1151. [PMID: 33574896 PMCID: PMC7864684 DOI: 10.3332/ecancer.2020.1151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Indexed: 12/29/2022] Open
Abstract
The topic of lactation following cancer diagnosis will become increasingly more current. Although oncological research confirms that breastfeeding after cancer might be possible, there is a lack of guidelines and a good recommendation for oncological women. In the absence of specific recommendations, women with past cancer may be at higher risk for psychological distress related to breastfeeding. The objective of this article was to analyse the experience of breastfeeding in new mothers with a history of cancer compared to women without a cancer diagnosis. First, we explored the impact of the cancer diagnosis on the breastfeeding choice. Second, we evaluated the relationship between different feeding methods and the mother’s mood states in women with and without a history of cancer. The sample was composed of 74 mothers divided into two groups: 34 with a cancer history (clinical sample) and 40 without a cancer diagnosis (control group). Participants were requested to complete a questionnaire three months after childbirth which assessed: socio-demographic and clinical data, feeding modes (breastfeeding, formula and mixed feeding) and the profile of mood states (POMS). Results showed that women in the clinical group breastfeed significantly less and use formula more than those in the control group. Moreover, in the clinical group, women who breastfeed feel reported higher levels of confusion (according to POMS) than mothers who bottle-feed or use a mixed feeding method. On the contrary, in the control sample, women who breastfeed feel significantly more vigorous than puerperae who bottle-feed or use mixed methods according to POMS. Our findings suggest the need for a specific warm chain of support and the development of guidelines with clear and specific information for women with a cancer diagnosis in order to reduce their confusion around breastfeeding.
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Affiliation(s)
- Martina Smorti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Via Paradisa 2, 56126 Pisa, Italy.,https://orcid.org/0000-0002-5867-9859
| | - Ilaria Testa
- ASST Bergamo Est Mental Health Department, via Paderno 21, 24068 Seriate BG, Italy
| | - Marta Gallese
- ASST Bergamo Est Mental Health Department, via Paderno 21, 24068 Seriate BG, Italy
| | - Arianna Dotti
- ASST Bergamo Est Mental Health Department, via Paderno 21, 24068 Seriate BG, Italy
| | - Chiara Ionio
- Department of Psychology, Catholic University of Milan, L.go Gemelli 1, 20123 Milano, Italy.,https://orcid.org/0000-0002-0163-3841
| | - Angelica Andreol
- Department of Psychology, Catholic University of Milan, L.go Gemelli 1, 20123 Milano, Italy
| | - Anna Zilioli
- ASST Bergamo Est Gynaecology-Obstetrical Department, via Paderno 21, 24068 Seriate BG, Italy
| | - Gabriella Pravettoni
- Istituto Europeo di Oncologia Milano, Applied Research Division for Cognitive and Psychological Science, Viale Ripamonti 435, 20141 Milano, Italy.,https://orcid.org/0000-0002-9135-2938
| | - Andrea Greco
- Department of Human and Social Sciences, University of Bergamo, P.le Sant'Agostino 2, 24129 Bergamo, Italy.,https://orcid.org/0000-0002-8086-2801
| | - Valentina Fenaroli
- ASST Bergamo Est Medical Department, via Paderno 21, 24068 Seriate BG, Italy.,https://orcid.org/0000-0002-5827-8369
| | - Giuseppe Nastasi
- ASST Bergamo Est Medical Department, via Paderno 21, 24068 Seriate BG, Italy
| | - Nicola Giuntini
- ASST Bergamo Est Medical Department, via Paderno 21, 24068 Seriate BG, Italy
| | - Lucia Bonassi
- ASST Bergamo Est Mental Health Department, via Paderno 21, 24068 Seriate BG, Italy.,https://orcid.org/0000-0001-5353-4899
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5
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Bhurosy T, Niu Z, Heckman CJ. Breastfeeding is Possible: A Systematic Review on the Feasibility and Challenges of Breastfeeding Among Breast Cancer Survivors of Reproductive Age. Ann Surg Oncol 2020; 28:3723-3735. [PMID: 32915334 DOI: 10.1245/s10434-020-09094-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/24/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Breastfeeding is the biologically normative mode of feeding human infants, and reduces the risk of breast cancer for mothers. This systematic review assesses engagement in breastfeeding and the factors associated with breastfeeding among breast cancer survivors. METHODS An online literature search was performed using the PubMed, Embase, CINAHL, PsychInfo, and Web of Science databases. Inclusion criteria were original research articles written in English, published in peer-reviewed journals from 1 January 1990 to 25 November 2019, and included data on breast cancer survivors who attempted breastfeeding. RESULTS Thirteen studies were included in the systematic review. Between 7.7 and 90.9% of women attempted breastfeeding. Breastfeeding among participants varied from a few weeks to approximately 2 years. Common factors leading to breastfeeding were use of the contralateral breast, support from others, lactation counseling and advice from an International Board-Certified Lactation Consultant, being motivated to breastfeed, frequent feedings, and use of galactagogues. Common barriers were medical counseling against breastfeeding, insufficient milk production, lack of support, refusal of the infant to breastfeed from the treated breast, and being tired from relying on one breast. CONCLUSIONS Breastfeeding from the unaffected breast is feasible for some breast cancer survivors. Successful breastfeeding may require multilevel support and expert advice.
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Affiliation(s)
- Trishnee Bhurosy
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
| | - Zhaomeng Niu
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Carolyn J Heckman
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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6
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Ford EL, Underwood MA, German JB. Helping Mom Help Baby: Nutrition-Based Support for the Mother-Infant Dyad During Lactation. Front Nutr 2020; 7:54. [PMID: 32373623 PMCID: PMC7186439 DOI: 10.3389/fnut.2020.00054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022] Open
Abstract
Lactation and breastfeeding support the short- and long-term health of both mother and infant, yet the success of these processes depend upon individual and combined factors of the pair. Complications during pregnancy and delivery greatly affect the likelihood that a mother will be capable of breastfeeding for at least the recommended 6 months. Guidelines for women regarding postpartum diet and lifestyle management also fail to reflect the diversity of mother-infant pairs and their circumstances. In our analysis of the literature, we have identified a categorical deficit in modern scientific discourse regarding human lactation; namely, that postpartum involves full-body contribution of resources and thus requires the application of nutrition from a systemic perspective.
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Affiliation(s)
- Erin L Ford
- Department of Food Science and Technology, Foods for Health Institute, University of California, Davis, Davis, CA, United States
| | | | - J Bruce German
- Department of Food Science and Technology, Foods for Health Institute, University of California, Davis, Davis, CA, United States.,Foods for Health Institute, University of California, Davis, Davis, CA, United States
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7
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Johnson HM, Mitchell KB. Breastfeeding and Breast Cancer: Managing Lactation in Survivors and Women with a New Diagnosis. Ann Surg Oncol 2019; 26:3032-3039. [PMID: 31342385 DOI: 10.1245/s10434-019-07596-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Supporting breastfeeding is a global health priority, yet few clinical guidelines exist to guide surgical oncologists in managing lactation during or after breast cancer treatment. METHODS The literature was reviewed to identify evidence-based strategies for managing lactation during multidisciplinary breast cancer treatment or among breast cancer survivors. RESULTS The majority of the evidence is from observational studies, with some higher levels of evidence, including systematic reviews and meta-analyses. Several significant gaps in knowledge remain. CONCLUSIONS This review serves as a comprehensive resource of evidence-based recommendations for managing lactation in breast cancer survivors and breastfeeding women with a new breast cancer diagnosis.
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Affiliation(s)
- Helen M Johnson
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Katrina B Mitchell
- Breast Surgical Oncology, Presbyterian Healthcare Services - MD Anderson Cancer Network, Albuquerque, NM, USA.
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8
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Abstract
When addressing the compatibility of breastfeeding with certain maternal conditions, we need to differentiate between "contraindication" and "obstacle." Failure to distinguish between the two confuses new mothers and their families, and engenders misconceptions about breastfeeding advice by health professionals. Health conditions that may simply impede the initiation and duration of breastfeeding are often wrongly referred to as true contraindications to breastfeed, under the assumption that they might harm the health of the mother and/or that of the nursing infant. Here, we discuss several topics, including breast surgery, prolactinoma, concurrent new pregnancy, hormonal contraception, and use of medications and contrast agents, that continue to raise controversy. While most conditions appear to be compatible with breastfeeding, the major determinants of a woman's final choice of whether to nurse her infant or not are the attitude of health professionals and the state of mind of being an informed mother.
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Affiliation(s)
- Riccardo Davanzo
- Division of Pediatrics and Neonatology, Department of Mother and Child Health, Ospedale Madonna delle Grazie, Matera, Italy.,Task Force on Breastfeeding, Ministry of Health, Rome, Italy
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9
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Sun L, Ang E, Ang WHD, Lopez V. Losing the breast: A meta-synthesis of the impact in women breast cancer survivors. Psychooncology 2017; 27:376-385. [DOI: 10.1002/pon.4460] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 04/04/2017] [Accepted: 05/15/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Lingshan Sun
- Gynaecology-Oncology Ward; KK Women's and Children's Hospital; Singapore
| | - Emily Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | | | - Violeta Lopez
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore; Singapore
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10
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Biglia N, Torrisi R, D'Alonzo M, Codacci Pisanelli G, Rota S, Peccatori FA. Attitudes on fertility issues in breast cancer patients: an Italian survey. Gynecol Endocrinol 2015; 31:458-64. [PMID: 25982361 DOI: 10.3109/09513590.2014.1003293] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fertility issues should be discussed with young women before the start of any anticancer treatment. The study is aimed to investigate the attitude on fertility among Italian oncologists and breast surgeons dealing with BCa, and to report the consensus achieved on specific statements. METHODS One hundred and sixty-two panelists anonymously expressed an opinion through a web-based platform on 19 statements based on the Delphi method. RESULTS Ninety-one percent of oncologists considered important to discuss with patients about fertility issues and 83% believed estrogens could stimulate the growth of hidden cancer cells in ER(+) tumors. Difficulties in accessing fertility preservation procedures were mainly due to patients' reluctance, but also to lack of coordination with the assisted reproduction specialists. No full consensus was reached on the prognostic role of pregnancy after BCa. Fifty-four percent of oncologists declared that pregnancy does not affect oncologic prognosis. Treatment with GnRHa during chemotherapy was considered the only mean for preserving ovarian function. CONCLUSIONS Fertility preservation in BCa patients is a well-accepted practice among Italian oncologists. A poor knowledge of this specific issue emerged from the survey, even if a certain degree of agreement was observed on most fertility-related issues.
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Affiliation(s)
- Nicoletta Biglia
- Department of Gynaecology and Obstetrics, University of Turin , Turin , Italy
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11
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de Pedro M, Otero B, Martín B. Fertility preservation and breast cancer: a review. Ecancermedicalscience 2015; 9:503. [PMID: 25729416 PMCID: PMC4335963 DOI: 10.3332/ecancer.2015.503] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Indexed: 12/29/2022] Open
Abstract
Breast cancer is the most common malignancy in women, and its incidence increases with age, with the majority of patients diagnosed after menopause. However, in 15–25% of cases, patients are premenopausal at the time of diagnosis, and about 7% of them are below the age of 40. Therefore, a considerable amount of young women are diagnosed with breast cancer during their reproductive life. Within this group, most cancer cases require cytotoxic chemotherapy and/or hormone therapy, which are responsible for a decrease in the patients’ reproductive function, along with their age. The efficacy of such treatments, among other factors, has led to a high five-year-survival rate, which results in an increasing number of young women who survive breast cancer before having fulfilled their reproductive wishes, especially considering the current trend to delay pregnancy until the late 30s or early 40s in developed countries. The combination of these factors justifies the importance of fertility preservation and reproductive counselling at the time of breast cancer diagnosis in young women. A wide range of fertility preservation techniques has been developed, such as ovarian suppression, oocyte and embryo cryopreservation, immature oocyte retrieval and in vitro maturation, and ovarian tissue cryopreservation. Early counselling and referral of these patients to fertility specialists are fundamental factors in order to maximise their chances of pregnancy. This review aims to update the knowledge about the influence of breast cancer in fertility, the influence of pregnancy and fertility preservation techniques in breast cancer patients and assessment of ovarian reserve for a better treatment choice. A special section dedicated to BRCA-mutation carriers has been included because of their specific features. A comprehensive literature search has been conducted, including publications from the last five years.
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Affiliation(s)
- María de Pedro
- Department of Obstetrics and Gynecology, HM Nuevo Belén University Hospital, HM Hospitales, José Silva 7, Madrid 28043, Spain
| | - Borja Otero
- Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology, Cruces University Hospital, Barakaldo 48903, Spain
| | - Belén Martín
- Department of Obstetrics and Gynecology, Getafe University Hospital, Getafe 28905, Spain
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12
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Meneses K, Holland AC. Current evidence supporting fertility and pregnancy among young survivors of breast cancer. J Obstet Gynecol Neonatal Nurs 2014; 43:374-81. [PMID: 24689363 DOI: 10.1111/1552-6909.12301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Approximately 6% of invasive breast cancer is diagnosed in women younger than age 40 of age childbearing potential. Cancer-directed therapies can cause hormonal and anatomical changes that negatively affect the reproductive potential of young survivors of breast cancer. Recent national guidelines on fertility preservation are widely available. However, gaps in care exist in the interdisciplinary evidence-based management of young survivors of breast cancer with fertility and parenting concerns after cancer treatment.
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13
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Goetz O, Burgy C, Langer C, Doyen C, Mathelin C. Allaitement après cancer du sein : enquête auprès des professionnels de santé hospitaliers en Alsace. ACTA ACUST UNITED AC 2014; 42:234-9. [DOI: 10.1016/j.gyobfe.2014.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
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14
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Margulies AL, Uzan C. Grossesse après cancer du sein. ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2285-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Abstract
With the increased use of fertility treatments, more women are having multiple births. The purpose of this case study is to describe the efforts of a woman who had undergone a single mastectomy to provide all the breast milk her twins would need with her 1 functioning breast. A review of the Cumulative Index to Nursing and Allied Health Literature and PubMed confirmed that this situation has not been previously discussed in the current literature. The mother worked with International Board Certified Lactation Consultants and other health care professionals to reach her goal. With active participation and planning, close follow-up after discharge, and support at home, this mother achieved her goal by 3 months and continued for over 2 years. International Board Certified Lactation Consultants should have early, open conversations with the woman with a mastectomy and actively support her with information and strategies to meet her goals.
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Affiliation(s)
- Allyson M Michaels
- Lactation Services, Martha Jefferson Hospital, Charlottesville, VA 22911, USA.
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16
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Azim HA, Kroman N, Paesmans M, Gelber S, Rotmensz N, Ameye L, De Mattos-Arruda L, Pistilli B, Pinto A, Jensen MB, Cordoba O, de Azambuja E, Goldhirsch A, Piccart MJ, Peccatori FA. Prognostic impact of pregnancy after breast cancer according to estrogen receptor status: a multicenter retrospective study. J Clin Oncol 2012; 31:73-9. [PMID: 23169515 DOI: 10.1200/jco.2012.44.2285] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We questioned the impact of pregnancy on disease-free survival (DFS) in women with history of breast cancer (BC) according to estrogen receptor (ER) status. PATIENTS AND METHODS A multicenter, retrospective cohort study in which patients who became pregnant any time after BC were matched (1:3) to patients with BC with similar ER, nodal status, adjuvant therapy, age, and year of diagnosis. To adjust for guaranteed time bias, each nonpregnant patient had to have a disease-free interval at least equal to the time elapsing between BC diagnosis and date of conception of the matched pregnant one. The primary objective was DFS in patients with ER-positive BC. DFS in the ER-negative cohort, whole population, and overall survival (OS) were secondary objectives. Subgroup analyses included DFS according to pregnancy outcome and BC-pregnancy interval. With a two-sided α = 5% and β = 20%, 645 ER-positive patients were required to detect a hazard ratio (HR) = 0.65. RESULTS A total of 333 pregnant patients and 874 matched nonpregnant patients were analyzed, of whom 686 patients had an ER-positive disease. No difference in DFS was observed between pregnant and nonpregnant patients in the ER-positive (HR = 0.91; 95% CI, 0.67 to 1.24, P = .55) or the ER-negative (HR = 0.75; 95% CI, 0.51 to 1.08, P = .12) cohorts. However, the pregnant group had better OS (HR = 0.72; 95% CI, 0.54 to 0.97, P = .03), with no interaction according to ER status (P = .11). Pregnancy outcome and BC-pregnancy interval did not seem to impact the risk of relapse. CONCLUSION Pregnancy after ER-positive BC does not seem to reduce the risk of BC recurrence.
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Affiliation(s)
- Hatem A Azim
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
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17
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Cardoso F, Loibl S, Pagani O, Graziottin A, Panizza P, Martincich L, Gentilini O, Peccatori F, Fourquet A, Delaloge S, Marotti L, Penault-Llorca F, Kotti-Kitromilidou AM, Rodger A, Harbeck N. The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer. Eur J Cancer 2012; 48:3355-77. [PMID: 23116682 DOI: 10.1016/j.ejca.2012.10.004] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 10/02/2012] [Accepted: 10/02/2012] [Indexed: 12/22/2022]
Abstract
EUSOMA (The European Society of Breast Cancer Specialists) is committed to writing recommendations on different topics of breast cancer care which can be easily adopted and used by health professionals dedicated to the care of patients with breast cancer in their daily practice. In 2011, EUSOMA identified the management of young women with breast cancer as one of the hot topics for which a consensus among European experts was needed. Therefore, the society recently organised a workshop to define such recommendations. Thirteen experts from the different disciplines met for two days to discuss the topic. This international and multidisciplinary panel thoroughly reviewed the literature in order to prepare evidence-based recommendations. During the meeting, two working groups were set up to discuss in detail diagnosis and loco-regional and systemic treatments, including both group aspects of psychology and sexuality. The conclusions reached by the working groups were then discussed in a plenary session to reach panel consensus. Whenever possible, a measure of the level of evidence (LoE) from 1 (the highest) to 4 (the lowest) degree, based on the methodology proposed by the US Agency for Healthcare Research and Quality (AHRQ), was assigned to each recommendation. The present manuscript presents the recommendations of this consensus group for the management of young women with breast cancer in daily clinical practice.
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Affiliation(s)
- Fatima Cardoso
- Breast Unit, Champalimaud Cancer Center, Lisbon, Portugal.
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18
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Christinat A, Pagani O. Fertility after breast cancer. Maturitas 2012; 73:191-6. [PMID: 23020991 DOI: 10.1016/j.maturitas.2012.07.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 07/12/2012] [Indexed: 12/13/2022]
Abstract
Breast cancer is the most common tumor in childbearing women. In the last decades, considerable improvement in breast cancer-related death has been achieved with adjuvant therapies (chemotherapy, endocrine and targeted therapies, radiotherapy) but at cost of significant long-term sequels, including infertility. Reproductive issues are of great importance to young women, in particular for those who did not complete their families before breast cancer diagnosis: patients should be adequately informed at the time of diagnosis about the risk of infertility and the available methods for fertility preservation. This review will focus on incidence and impact of infertility secondary to breast cancer treatment, the available options for ovarian function preservation, including embryo and oocyte cryopreservation, ovarian tissue cryopreservation, and ovarian suppression with gonadotropin-releasing hormone agonists. We will also discuss the optimal time of subsequent pregnancy, the potential risks for the mother and the fetus, and the impact of therapies on breastfeeding.
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Margulies AL, Berveiller P, Mir O, Uzan C, Chabbert-Buffet N, Rouzier R. Grossesse après cancer du sein : mise à jour des connaissances en 2012. ACTA ACUST UNITED AC 2012; 41:418-26. [DOI: 10.1016/j.jgyn.2012.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 05/14/2012] [Accepted: 05/21/2012] [Indexed: 11/30/2022]
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20
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Abstract
Most young breast cancer survivors consider reproductive issues to be of great importance, but many questions remain undervalued and unanswered. Overall, available data support the safety and feasibility of pregnancy and breastfeeding after breast cancer. The accuracy of the evidence is however limited by: i) the retrospective and frequently incomplete population-based nature of the data, ii) data not representing the entire population, iii) patient-related effects, iv) underpowered sample size, and v) lack of control for biological factors and risk determinants. We review the available evidence in light of these limitations which outline the need for prospective data collection and focused priority research.
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Affiliation(s)
- Olivia Pagani
- Institute of Oncology of Southern Switzerland, Breast Unit of Southern Switzerland, Ospedale san Giovanni, Bellinzona, Switzerland
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Pinto AC, de Azambuja E. Improving quality of life after breast cancer: Dealing with symptoms. Maturitas 2011; 70:343-8. [DOI: 10.1016/j.maturitas.2011.09.008] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 09/22/2011] [Indexed: 11/16/2022]
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Azim HA, Peccatori FA, de Azambuja E, Piccart MJ. Motherhood after breast cancer: searching for la dolce vita. Expert Rev Anticancer Ther 2011; 11:287-98. [PMID: 21342046 DOI: 10.1586/era.10.208] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Advances in the field of adjuvant therapy in breast cancer have led to significant improvements in breast cancer survival. This has resulted in a progressive decline in breast cancer-related mortality, such that in 2010 there were estimated to be 400,000 breast cancer survivors under the age of 40 in the USA. Hence, enquiry into the feasibility of fertility preservation, subsequent pregnancy and breastfeeding is increasingly encountered. Fertility counseling remains suboptimal in breast cancer clinics, and there is a wide perception that pregnancy could worsen the prognosis of young breast cancer survivors, despite the lack of evidence supporting this notion. In addition, fertility preservation by means of embryo or oocyte cryopreservation requires ovarian stimulation, which is associated with a significant rise in estradiol levels and might delay initiation of therapy. All these factors, and others, have influenced the quality of fertility counseling offered to young breast cancer patients. In this article, we will critically analyze the available clinical and biological evidence on the safety and feasibility of pregnancy and breastfeeding following breast cancer. In addition, we will discuss the different fertility-preservation techniques available for these patients.
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Affiliation(s)
- Hatem A Azim
- Department of Medical Oncology, Jules Bordet Institute, Boulevard de Waterloo 121, 1000 Brussels, Belgium
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23
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Pregnancy after breast cancer: if you wish, ma’am. Breast Cancer Res Treat 2011; 129:309-17. [DOI: 10.1007/s10549-011-1643-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 06/13/2011] [Indexed: 10/18/2022]
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24
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Breastfeeding in breast cancer survivors: pattern, behaviour and effect on breast cancer outcome. Breast 2011; 19:527-31. [PMID: 21078487 DOI: 10.1016/j.breast.2010.05.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 05/27/2010] [Indexed: 01/16/2023] Open
Abstract
Little is known regarding the safety and feasibility of breastfeeding in women with a history of breast cancer. We have performed a survey among breast cancer patients who completed their pregnancy following breast cancer management to examine their lactation behaviours and its effect on breast cancer outcome. Out of 32 women identified, 20 were reachable and accepted to take the questionnaire. Ten women initiated breastfeeding, 4 stopped within one month and 6 had long-term success with a median period of 11 months (7-17 months). The latter were all previously subjected to breast conserving surgery and received qualified lactation counselling at delivery. The main reasons for not initiating breastfeeding were "uncertainty regarding maternal safety" and "a priori unfeasibility" expressed either by the obstetrician or by the oncologist. At a median follow-up of 48 months following delivery, all 20 women were alive with two relapses; one in each group (i.e., lactating and non-lactating). This analysis adds to the limited available evidence on the feasibility and safety of breastfeeding in breast cancer survivors. Proper fertility and survivorship counselling is crucial and requires more attention in breast cancer clinics.
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Azim HA, de Azambuja E, Colozza M, Bines J, Piccart MJ. Long-term toxic effects of adjuvant chemotherapy in breast cancer. Ann Oncol 2011; 22:1939-1947. [PMID: 21289366 DOI: 10.1093/annonc/mdq683] [Citation(s) in RCA: 179] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Breast cancer is the most common malignant tumor affecting women. Adjuvant systemic therapies have been shown to have a significant impact on reducing the risk for breast cancer recurrence and overall mortality. Chemotherapy remains an important and frequently used treatment option in the adjuvant setting, and the associated short-term adverse events are very well described. However, there is insufficient information regarding the long-term sequelae of most chemotherapeutic agents. In this review, we describe different potential long-term adverse events associated with adjuvant chemotherapy in breast cancer, with a particular focus on long-term cardiac toxicity, secondary leukemia, cognitive function, and neurotoxicity. In addition, we discuss the effect of adjuvant chemotherapy on fertility and sexual function of young breast cancer patients. These adverse events are frequently overshadowed by the well-demonstrated clinical efficacy and/or reassuring short-term safety profiles of the different chemotherapy regimens commonly used today. We believe that a proper understanding and appreciation of these adverse events will enable us to refine our strategies for managing breast cancer. The fact that adjuvant chemotherapy is often given to patients who might not really need it urges us to consider the whole spectrum of chemotherapy risks versus benefits to maximize benefit without compromising quality of life.
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Affiliation(s)
- H A Azim
- Department of Medical Oncology, Jules Bordet Institute, Brussels, Belgium
| | - E de Azambuja
- Department of Medical Oncology, Jules Bordet Institute, Brussels, Belgium
| | - M Colozza
- Department of Oncology, Terni Hospital, Terni, Italy
| | - J Bines
- Department of Clinical Oncology, University Hospital of Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - M J Piccart
- Department of Medical Oncology, Jules Bordet Institute, Brussels, Belgium.
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Safety of pregnancy following breast cancer diagnosis: A meta-analysis of 14 studies. Eur J Cancer 2011; 47:74-83. [DOI: 10.1016/j.ejca.2010.09.007] [Citation(s) in RCA: 190] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 08/28/2010] [Accepted: 09/02/2010] [Indexed: 12/23/2022]
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de Bree E, Makrigiannakis A, Askoxylakis J, Melissas J, Tsiftsis DD. Pregnancy after breast cancer. A comprehensive review. J Surg Oncol 2010; 101:534-42. [PMID: 20401921 DOI: 10.1002/jso.21514] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Pregnancy after breast cancer treatment has become an important issue since many young breast cancer patients have not completed their family. Generally, these patients should not be discouraged to become pregnant when they want to, since published data suggest no adverse effect of pregnancy on survival. As fertility may be impaired by chemotherapy, different fertility preserving strategies have been developed. Births seem to sustain no adverse effects, while breastfeeding appears to be feasible and safe.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, Herakleion, Greece.
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28
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Peccatori FA, Azim HA. Pregnancy in breast cancer survivors: A need for proper counseling. Breast 2009; 18:337-8. [DOI: 10.1016/j.breast.2009.09.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gorman JR, Usita PM, Madlensky L, Pierce JP. A qualitative investigation of breast cancer survivors' experiences with breastfeeding. J Cancer Surviv 2009; 3:181-91. [PMID: 19462249 PMCID: PMC2714446 DOI: 10.1007/s11764-009-0089-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 05/06/2009] [Indexed: 12/29/2022]
Abstract
INTRODUCTION This is an exploratory, qualitative investigation of breast cancer survivors' experiences with breastfeeding. Previous studies have focused on the physiology of lactation after surgery and treatment, but have not explored factors influencing breastfeeding decisions and behavior. METHODS We used purposeful sampling to identify 11 breast cancer survivors who had a child after their diagnosis and treatment. Participants were recruited from among those in the Women's Healthy Eating and Living (WHEL) study and a Young Survival Coalition (YSC) affiliate. We conducted semi-structured, open-ended telephone interviews lasting 45-75 min. We used social cognitive theory (SCT) to structure questions regarding influences on breastfeeding behavior. We transcribed interviews and used cross-case, inductive analysis to identify themes. RESULTS Ten of 11 participants initiated breastfeeding. The following main themes emerged: 1) Cautiously hopeful, 2) Exhausting to rely on one breast, 3) Motivated despite challenges, 4) Support and lack of support, and 5) Encouraging to others. DISCUSSION/CONCLUSIONS Study participants were highly motivated to breastfeed but faced considerable challenges. Participants described problems that are not unique to women with breast cancer, but experienced these to a much greater degree because they relied mostly or entirely on one lactating breast. This study revealed a need for improved access to information and support and greater sensitivity to the obstacles faced by breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Results of this qualitative analysis indicate that interventions to support the efforts of breast cancer survivors who are interested in breastfeeding are warranted. Additional research would aid in the development of such interventions.
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Affiliation(s)
- Jessica R. Gorman
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA 92093-0901 USA
| | - Paula M. Usita
- Division of Health Promotion and Behavioral Sciences, Graduate School of Public Health, San Diego State University, San Diego, CA 92182 USA
| | - Lisa Madlensky
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA 92093-0901 USA
| | - John P. Pierce
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA 92093-0901 USA
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Bercovich D, Goodman G. Pregnancy and lactation after breast cancer elevate plasma prolactin, do not shorten and may prolong survival. Med Hypotheses 2009; 73:942-7. [PMID: 19632054 DOI: 10.1016/j.mehy.2009.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 06/13/2009] [Indexed: 01/19/2023]
Abstract
The affliction of breast cancer is doubled for young patients wishing to have a child. Because estrogens can cause breast cancer and its elevation during pregnancy, clinical advice historically restricted pregnancy to at least 5 years post-diagnosis. Opposing evidence gradually relaxed this. Furthermore, in the last decade it was clarified that overall, post-treatment pregnancy and breast-feeding do not shorten survival. Despite this evidence and patients such as S.B. (deceased) and remarkable L.H. (five children, starting immediately after treatment for node-positive breast cancer), much opposition and restrictive advice remain: additional therapy preferred over pregnancy. In healthy women, pregnancy reduces (cause unknown) the risk of breast cancer and lactation may reduce it. These are accompanied by highly elevated plasma prolactin (PRL) over many months (pregnancy, 15-25 x daily mean 10 ng/ml; lactation, up to 30 x daily mean). PRL concentration too increases in other natural and non-biological conditions, also apparently without increasing breast cancer incidence. Nevertheless, firm and implied support for early pregnancy (and lactation) post-diagnosis and treatment may face a new issue. Over a decade, some studies have claimed epidemiological evidence that a relatively minute PRL elevation (from zero to 0.6-0.8 ng/ml) over mean level increases the risk of breast cancer (i.e. it is a carcinogen) and that this supports (and is supported by) a similar view from some laboratory research. This two-pronged mutuality could create further anxiety and unjustified advice dashing the wish for a child. Is this justified? Epidemiology on PRL and breast cancer risk in the eighties/nineties was contradictory and inconclusive; in the last decade, it was also biologically implausible. 'Positive' laboratory results targeting a 'tamoxifen for PRL' have over-shadowed confounding, negative (often called 'inconsistent') laboratory evidence. Increasingly evident complexity of conflicting biochemical, hormonal, cellular and tissue interactions, confused further by failure of molecular genetics to confirm PRL as a carcinogen, make this target more a mirage than an oasis. While recognizing the value of laboratory research primarily for facts, future progress will be most sound and rapid from observation starting with the human entity, not with its parts. Molecular genetics makes this possible and will be the epicentre of breast cancer research. Meanwhile, young breast cancer patients after initial treatment and eager for a child can today reasonably benefit from advice based on phenomena evolved over eons: pregnancy, lactation and accompanying highly-elevated PRL will not increase risk of recurrence and will in some cases prolong survival.
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Affiliation(s)
- Dani Bercovich
- Human Molecular Genetics and Pharmacogenetics, Migal Biotechnology Institute, Galilee, POB 831, Kiryat Shmona 11016, Israel
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