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Roberts JE, Benoit J, Foong S, Saumet J, Korkidakis A, Marr K, McQuillan S, Todd N. Fertility preservation in patients undergoing gonadotoxic treatments: a Canadian Fertility and Andrology Society clinical practice guideline. Reprod Biomed Online 2024; 48:103767. [PMID: 38458057 DOI: 10.1016/j.rbmo.2023.103767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 03/10/2024]
Abstract
The management of young patients with cancer presents several unique challenges. In general, these patients are ill prepared for the diagnosis and the impact on their fertility. With the improved survival for all tumour types and stages, the need for adequate fertility counselling and a multidisciplinary approach in the reproductive care of these patients is paramount. Recent advances in cryopreservation techniques allow for the banking of spermatozoa, oocytes, embryos and ovarian tissue without compromising survival. This Canadian Fertility and Andrology Society (CFAS) guideline outlines the current understanding of social and medical issues associated with oncofertility, and the medical and surgical technologies available to optimize future fertility.
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Affiliation(s)
- Jeffrey E Roberts
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, B.C., Canada.
| | - Janie Benoit
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Shu Foong
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - Julio Saumet
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Ann Korkidakis
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard University, Boston, MA, USA
| | - Kristin Marr
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, B.C., Canada
| | - Sarah McQuillan
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - Nicole Todd
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, B.C., Canada
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Timofeeva AM, Paramonik AP, Sedykh SS, Nevinsky GA. Milk Exosomes: Next-Generation Agents for Delivery of Anticancer Drugs and Therapeutic Nucleic Acids. Int J Mol Sci 2023; 24:10194. [PMID: 37373342 DOI: 10.3390/ijms241210194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Exosomes are nanovesicles 40-120 nm in diameter secreted by almost all cell types and providing humoral intercellular interactions. Given the natural origin and high biocompatibility, the potential for loading various anticancer molecules and therapeutic nucleic acids inside, and the surface modification possibility for targeted delivery, exosomes are considered to be a promising means of delivery to cell cultures and experimental animal organisms. Milk is a unique natural source of exosomes available in semi-preparative and preparative quantities. Milk exosomes are highly resistant to the harsh conditions of the gastrointestinal tract. In vitro studies have demonstrated that milk exosomes have an affinity to epithelial cells, are digested by cells by endocytosis mechanism, and can be used for oral delivery. With milk exosome membranes containing hydrophilic and hydrophobic components, exosomes can be loaded with hydrophilic and lipophilic drugs. This review covers a number of scalable protocols for isolating and purifying exosomes from human, cow, and horse milk. Additionally, it considers passive and active methods for drug loading into exosomes, as well as methods for modifying and functionalizing the surface of milk exosomes with specific molecules for more efficient and specific delivery to target cells. In addition, the review considers various approaches to visualize exosomes and determine cellular localization and bio-distribution of loaded drug molecules in tissues. In conclusion, we outline new challenges for studying milk exosomes, a new generation of targeted delivery agents.
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Affiliation(s)
- Anna M Timofeeva
- SB RAS Institute of Chemical Biology and Fundamental Medicine, 630090 Novosibirsk, Russia
- Faculty of Natural Sciences, Novosibirsk State University, 630090 Novosibirsk, Russia
| | - Anastasia P Paramonik
- SB RAS Institute of Chemical Biology and Fundamental Medicine, 630090 Novosibirsk, Russia
- Faculty of Natural Sciences, Novosibirsk State University, 630090 Novosibirsk, Russia
| | - Sergey S Sedykh
- SB RAS Institute of Chemical Biology and Fundamental Medicine, 630090 Novosibirsk, Russia
- Faculty of Natural Sciences, Novosibirsk State University, 630090 Novosibirsk, Russia
| | - Georgy A Nevinsky
- SB RAS Institute of Chemical Biology and Fundamental Medicine, 630090 Novosibirsk, Russia
- Faculty of Natural Sciences, Novosibirsk State University, 630090 Novosibirsk, Russia
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Guidelines for Cancer Treatment during Pregnancy: Ethics-Related Content Evolution and Implications for Clinicians. Cancers (Basel) 2022; 14:cancers14174325. [PMID: 36077859 PMCID: PMC9454868 DOI: 10.3390/cancers14174325] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/28/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
Simple Summary Clinical practice guidelines for cancer treatment during pregnancy have been available for the past 20 years; however, whether they contain bioethical guidance is currently unknown. A systematic medical literature review was performed to identify the presence of biomedical ethics principles present in guidelines published until 2021. Most of the included guidelines (25 out of 32) refer to biomedical ethics principles such as respect for patient’s autonomy, beneficence and justice. Earlier guidelines stress the importance of patient wishes and choices in light of limited evidence and vast unknowns while balancing maternal and fetal wellbeing. More recent guidelines tend to focus on evidence-based data to balance favorable outcomes for pregnant patients and their fetuses with counselling support to help the patients and their support network understand the rationale behind available treatment options. However, ethics-related content in such guidelines is not presented in a structured manner, indicating the need for methodological upgrades. Therefore, a more structured approach is needed when addressing existing and potential ethical issues in clinical practice guidelines for cancer treatment during pregnancy. Abstract (1) Background: Current scientific evidence suggests that most cancers, including breast cancer, can be treated during pregnancy without compromising maternal and fetal outcomes. This, however, raises questions regarding the ethical implications of clinical care. (2) Methods: Using a systematic literature search, 32 clinical practice guidelines for cancer treatment during pregnancy published between 2002 and 2021 were selected for analysis and 25 of them mentioned or made references to medical ethics when offering clinical management guidance for clinicians. (3) Results: Four bioethical themes were identified: respect for patient’s autonomy, balanced approach to maternal and fetal beneficence, protection of the vulnerable and justice in resource allocation. Most guidelines recommended informing the pregnant patient about available evidence-based treatment options, offering counselling and support in the process of decision making. The relational aspect of a pregnant patient’s autonomy was also recognized and endorsed in a significant number of available guidelines. (4) Conclusions: Recognition and support of a patient’s autonomy and its relational aspects should remain an integral part of future clinical practice guidelines. Nevertheless, a more structured approach is needed when addressing existing and potential ethical issues in clinical practice guidelines for cancer treatment during pregnancy.
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Kaidar-Person O, Yoeli-Ullman R, Pillar N, Paluch-Shimon S, Poortmans P, Lawrence YR. Obstetric complications at time of delivery amongst breast cancer survivors: A population-based cohort study. Breast 2022; 62:170-178. [PMID: 35219114 PMCID: PMC8873951 DOI: 10.1016/j.breast.2022.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Our aim was to determine whether breast cancer survivors are at increased risk of obstetric and maternal complications at time of delivery. METHODS The USA 'National Inpatient Sample' database was queried for hospitalizations associated with deliveries, between 2015 and 2018. The incidence of maternal and fetal complications was compared between women with, and without, a personal history of breast cancer. RESULTS Of the 2,103,216 birth related admissions, 617 (0.03%) of the women were breast cancer survivors, with the proportion increasing over time (from 0.02% in 2015 to 0.04% in 2018). Breast cancer survivors had a higher socioeconomic status (p < 0.001) and were significantly older compared to other mothers (34 vs. 28 years, p < 0.001). Additionally, they were more likely to suffer from preexisting chronic diseases including cardiopulmonary disease and diabetes mellitus, and had a higher incidence of multiple gestation (4.4% vs. 1.6%) [OR 2.7, 95% CI 1.9-4.0, p < 0.001]. The incidence of acute adverse events at time of delivery including fetal distress, preterm labor, cesarean section and maternal infection was higher amongst the breast cancer survivors. On multivariate analysis age, ethnic group, comorbidities, multiple gestations, and a previous breast cancer diagnosis, but not cancer treatment, were associated with an increased risk of an obstetric adverse event. CONCLUSION Breast cancer survivors have more comorbidities and are at increased risk of acute obstetrical complications at time of delivery. Further studies are required to validate these findings, and evaluate the ability of interventions to improve obstetrical outcomes amongst breast cancer survivors.
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Affiliation(s)
- Orit Kaidar-Person
- Department of Radiation Oncology, Sheba Medical Center, Tel HaShomer, 5265601, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Rakefet Yoeli-Ullman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Nir Pillar
- Department of Pathology, Hadassah-Hebrew-University-Medical-Center, Jerusalem, 91120, Israel
| | - Shani Paluch-Shimon
- Sharett Institute of Oncology, Hadassah University Hospital & Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, 2610, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | - Yaacov R Lawrence
- Department of Radiation Oncology, Sheba Medical Center, Tel HaShomer, 5265601, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, USA
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Vohra SN, Reeder-Hayes KE, Nichols HB, Emerson MA, Love MI, Olshan AF, Troester MA. Breast cancer treatment patterns by age and time since last pregnancy in the Carolina Breast Cancer Study Phase III. Breast Cancer Res Treat 2022; 192:435-445. [PMID: 35006482 PMCID: PMC8930462 DOI: 10.1007/s10549-022-06511-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe breast cancer treatment patterns among premenopausal women by age and time since last pregnancy. METHODS Data were analyzed from 1179 women diagnosed with premenopausal breast cancer in the Carolina Breast Cancer Study. Of these, 160 had a recent pregnancy (within 5 years of cancer diagnosis). Relative frequency differences (RFDs) and 95% confidence intervals (CIs) were used to compare cancer stage, treatment modality received, treatment initiation delay (> 30 days), and prolonged treatment duration (> 2 to > 8 months depending on the treatment received) by age and recency of pregnancy. RESULTS Recently postpartum women were significantly more likely to have stage III disease [RFD (95% CI) 12.2% (3.6%, 20.8%)] and to receive more aggressive treatment compared to nulliparous women. After adjustment for age, race and standard clinical tumor characteristics, recently postpartum women were significantly less likely to have delayed treatment initiation [RFD (95% CI) - 11.2% (- 21.4%, - 1.0%)] and prolonged treatment duration [RFD (95% CI) - 17.5% (- 28.0%, - 7.1%)] and were more likely to have mastectomy [RFD (95% CI) 14.9% (4.8%, 25.0%)] compared to nulliparous. Similarly, younger women (< 40 years of age) were significantly less likely to experience prolonged treatment duration [RFD (95% CI) - 5.6% (- 11.1%, - 0.0%)] and more likely to undergo mastectomy [RFD (95% CI) 10.6% (5.2%, 16.0%)] compared to the study population as a whole. CONCLUSION These results suggest that recently postpartum and younger women often received prompt and aggressive breast cancer treatment. Higher mortality and recurrence among recently pregnant women are unlikely to be related to undertreatment.
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Affiliation(s)
- Sanah N Vohra
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Katherine E Reeder-Hayes
- Division of Hematology/Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marc A Emerson
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael I Love
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melissa A Troester
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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6
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Success and risks of pregnancy after breast cancer. Breast Cancer Res Treat 2021; 188:593-600. [PMID: 33884537 DOI: 10.1007/s10549-021-06232-5] [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: 01/13/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Breast cancer is the most common cancer in women worldwide. The number of childbearing-age women diagnosed with early breast cancer (eBC) is increasing, raising questions over their subsequent fertility. PURPOSE The main objective of this study was therefore to assess, in a cohort of eBC patients with pregnancy desire, the rate of live births achieved spontaneously or by assisted reproductive technology. METHODS We conducted an observational, descriptive, retrospective study including patients aged 18-40, treated for eBC at the Institut de Cancérologie de l'Ouest (ICO) Pays de Loire between July 2010 and July 2016, with pregnancy desire. The primary outcome was the rate of live births. Secondary outcomes were overall survival, disease-free survival, time to conception, and spontaneous or assisted pregnancy rate. RESULTS 61 patients were included, with a live birth rate of 19.7% (12/61). We observed no recurrence or death in women with a pregnancy. Pregnancy started with a median time of 36.4 months after the end of treatment (4.1-51.3 months). All pregnancies in this cohort were achieved spontaneously. CONCLUSION The results of our cohort are consistent with previous results showing that spontaneous pregnancy remains possible after treatment for eBC without increasing the risk of recurrence or death.
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Shah AN, Luck M, Goldman K, Gradishar W. Addressing Fertility: an Essential Aspect of Comprehensive Care for Young Patients with Breast Cancer. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00396-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nejatisafa AA, Faccio F, Nalini R. Psychological Aspects of Pregnancy and Lactation in Patients with Breast Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1252:199-207. [PMID: 32816283 DOI: 10.1007/978-3-030-41596-9_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Young breast cancer patients face numerous challenges during the cancer trajectory. As in the last decade, women tend to delay pregnancies to a later time in life, and clinicians are often faced with young breast cancer patients who want to start a family or complete it. Becoming a mother is a delicate developmental process in which the woman redefines and restructures her identity as she gets prepared for her new role and responsibilities. When there is a history of cancer or cancer diagnosis is communicated during the pregnancy, fears, worries, and concerns emerge and specific support may be necessary. Follow-ups during the post-partum period are also recommended as lactation issues should not be overlooked. In this chapter, we analyze the psychological aspects of cancer survivors and women with pregnancy-associated breast cancer, and the management of these issues.
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Affiliation(s)
- Ali-Akbar Nejatisafa
- Department of Psychiatry, Division of Psychosomatic Medicine, Psychosomatic Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Flavia Faccio
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Ronak Nalini
- Department of Internal Medicine, Division of Hematology-Oncology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Linkeviciute A, Notarangelo M, Buonomo B, Bellettini G, Peccatori FA. Breastfeeding After Breast Cancer: Feasibility, Safety, and Ethical Perspectives. J Hum Lact 2020; 36:40-43. [PMID: 31730386 DOI: 10.1177/0890334419887723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Barbara Buonomo
- IEO European Institute of Oncology IRCCS, Milan, Italy.,University of Naples Federico II, Naples, Italy
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Faccio F, Mascheroni E, Ionio C, Pravettoni G, Alessandro Peccatori F, Pisoni C, Cassani C, Zambelli S, Zilioli A, Nastasi G, Giuntini N, Bonassi L. Motherhood during or after breast cancer diagnosis: A qualitative study. Eur J Cancer Care (Engl) 2020; 29:e13214. [PMID: 31904906 DOI: 10.1111/ecc.13214] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 10/25/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Little is known about the process of becoming a mother in women who experienced a breast cancer diagnosis (BC). In this qualitative study, we investigated maternal representations in pregnant women with experience of BC and those with no oncological history. METHODS A total of 38 women were recruited, 19 women who experienced a BC diagnosis and 19 who had not. To explore maternal representations, semi-structured interviews were conducted and analysed through thematic analysis. RESULTS Four main themes were identified: fears and worries, meaning of motherhood, mother-foetus relationship and partner support. Across themes, differences between primiparous and multiparous are reported. Women with gestational breast cancer (GBC) described fear for their own and their child's survival. Women with previous BC recall contrasting emotions. All women with experience of BC perceived breastfeeding as fundamental and inability to do so provoked worry. Relationship with the partner was considered central, while healthy women were projected towards the future triadic relationship. CONCLUSIONS Finding a mental space during pregnancy for the representation of the future child could be hard for women with GBC. Dissimilarities in the experience of motherhood in cancer patients provide insight into psychological aspects that should be taken into account in clinical practice.
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Affiliation(s)
- Flavia Faccio
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Eleonora Mascheroni
- CRIdee, Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Chiara Ionio
- CRIdee, Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Fedro Alessandro Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Division, European Institute of Oncology IRCCS, Milan, Italy
| | - Camilla Pisoni
- Neonatal Intensive Care Unit, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Sara Zambelli
- Department of Mental Health, ASST Bergamo Est, Seriate, Italy
| | - Anna Zilioli
- Department of Mental Health, ASST Bergamo Est, Seriate, Italy
| | | | | | - Lucia Bonassi
- Department of Mental Health, ASST Bergamo Est, Seriate, Italy
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Abstract
Breastfeeding is an important aspect of mother-newborn relationship and is of great benefit for the baby. Unfortunately, many drugs taken by the mother may pass into her milk and exert an effect on the newborn. Very limited data is available and a cautionary approach is warranted especially when the woman receives anticancer treatment including chemotherapy , hormonal treatment and the recently introduced target agents as well as monoclonal antibodies. In all these conditions breastfeeding should be put on hold.More and more often physicians are faced with women that are pregnant years after the diagnosis of cancer: this has long been considered dangerous for the mother, but data show that prognosis is definitely not worse. If the woman is no longer being actively treated, breastfeeding is advisable every time it is possible, even if patients that received breast radiation may be unable to produce a sufficient amount of milk on that side.
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Comment on "Bariatric Surgery is Associated With Reduced Risk of Breast Cancer in Both Premenopausal and Postmenopausal Women". Ann Surg 2019; 271:e19. [PMID: 31577549 DOI: 10.1097/sla.0000000000003607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Mitchell KB, Fleming MM, Anderson PO, Giesbrandt JG, Noble L, Reece-Stremtan S, Bartick M, Calhoun S, Dodd S, Elliott-Rudder M, Kair LR, Lappin S, Lawrence RA, LeFort Y, Marinelli KA, Marshall N, Murak C, Myers E, Okogbule-Wonodi A, Roberts A, Rosen-Carole C, Rothenberg S, Schmidt T, Seo T, Sriraman N, Stehel EK, Fleur RS, Wight N, Winter L. ABM Clinical Protocol #30: Radiology and Nuclear Medicine Studies in Lactating Women. Breastfeed Med 2019; 14:290-294. [PMID: 31107104 DOI: 10.1089/bfm.2019.29128.kbm] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Katrina B Mitchell
- 1 Presbyterian Healthcare Services-MD Anderson Cancer Network, Albuquerque, New Mexico
| | | | - Philip O Anderson
- 3 Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California
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ACR Appropriateness Criteria ® Breast Imaging of Pregnant and Lactating Women. J Am Coll Radiol 2019; 15:S263-S275. [PMID: 30392595 DOI: 10.1016/j.jacr.2018.09.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
Breast imaging during pregnancy and lactation is challenging due to unique physiologic and structural breast changes that increase the difficulty of clinical and radiological evaluation. Pregnancy-associated breast cancer (PABC) is increasing as more women delay child bearing into the fourth decade of life, and imaging of clinical symptoms should not be delayed. PABC may present as a palpable lump, nipple discharge, diffuse breast enlargement, focal pain, or milk rejection. Breast imaging during lactation is very similar to breast imaging in women who are not breast feeding. However, breast imaging during pregnancy is modified to balance both maternal and fetal well-being; and there is a limited role for advanced breast imaging techniques in pregnant women. Mammography is safe during pregnancy and breast cancer screening should be tailored to patient age and breast cancer risk. Diagnostic breast imaging during pregnancy should be obtained to evaluate clinical symptoms and for loco-regional staging of newly diagnosed PABC. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Grossesse après cancer du sein : revue de la littérature. Presse Med 2019; 48:376-383. [DOI: 10.1016/j.lpm.2019.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 02/14/2017] [Accepted: 01/31/2019] [Indexed: 11/18/2022] Open
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Sankatsing VDV, Fracheboud J, de Munck L, Broeders MJM, van Ravesteyn NT, Heijnsdijk EAM, Verbeek ALM, Otten JDM, Pijnappel RM, Siesling S, de Koning HJ. Detection and interval cancer rates during the transition from screen-film to digital mammography in population-based screening. BMC Cancer 2018; 18:256. [PMID: 29506487 PMCID: PMC5839006 DOI: 10.1186/s12885-018-4122-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 02/12/2018] [Indexed: 12/29/2022] Open
Abstract
Background Between 2003 and 2010 digital mammography (DM) gradually replaced screen-film mammography (SFM) in the Dutch breast cancer screening programme (BCSP). Previous studies showed increases in detection rate (DR) after the transition to DM. However, national interval cancer rates (ICR) have not yet been reported. Methods We assessed programme sensitivity and specificity during the transition period to DM, analysing nationwide data on screen-detected and interval cancers. Data of 7.3 million screens in women aged 49–74, between 2004 and 2011, were linked to the Netherlands Cancer Registry to obtain data on interval cancers. Age-adjusted DRs, ICRs and recall rates (RR) per 1000 screens and programme sensitivity and specificity were calculated by year, age and screening modality. Results 41,662 screen-detected and 16,160 interval cancers were analysed. The DR significantly increased from 5.13 (95% confidence interval (CI):5.00–5.30) in 2004 to 6.34 (95% CI:6.15–6.47) in 2011, for both in situ (2004:0.73;2011:1.24) and invasive cancers (2004:4.42;2011:5.07), whereas the ICR remained stable (2004: 2.16 (95% CI2.06–2.25);2011: 2.13 (95% CI:2.04–2.22)). The RR changed significantly from 14.0 to 21.4. Programme sensitivity significantly increased, mainly between ages 49–59, from 70.0% (95% CI:68.9–71.2) to 74.4% (95% CI:73.5–75.4) whereas specificity slightly declined (2004:99.1% (95% CI:99.09–99.13);2011:98.5% (95% CI:98.45–98.50)). The overall DR was significantly higher for DM than for SFM (6.24;5.36) as was programme sensitivity (73.6%;70.1%), the ICR was similar (2.19;2.20) and specificity was significantly lower for DM (98.5%;98.9%). Conclusions During the transition from SFM to DM, there was a significant rise in DR and a stable ICR, leading to increased programme sensitivity. Although the recall rate increased, programme specificity remained high compared to other countries. These findings indicate that the performance of DM in a nationwide screening programme is not inferior to, and may be even better, than that of SFM. Electronic supplementary material The online version of this article (10.1186/s12885-018-4122-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Valérie D V Sankatsing
- Department of Public Health, Erasmus MC, PO Box 2040, Rotterdam, 3015, CN, The Netherlands.
| | - Jacques Fracheboud
- Department of Public Health, Erasmus MC, PO Box 2040, Rotterdam, 3015, CN, The Netherlands
| | - Linda de Munck
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), PO Box 19079, Utrecht, 3501, DB, The Netherlands
| | - Mireille J M Broeders
- Department for Health Evidence, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500, HB, The Netherlands.,Dutch Reference Center for Screening, PO Box 6873, Nijmegen, 6503, GJ, The Netherlands
| | | | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, PO Box 2040, Rotterdam, 3015, CN, The Netherlands
| | - André L M Verbeek
- Department for Health Evidence, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500, HB, The Netherlands
| | - Johannes D M Otten
- Department for Health Evidence, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500, HB, The Netherlands
| | - Ruud M Pijnappel
- Dutch Reference Center for Screening, PO Box 6873, Nijmegen, 6503, GJ, The Netherlands.,Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), PO Box 19079, Utrecht, 3501, DB, The Netherlands.,Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, PO Box 217, Enschede, 7500, AE, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, PO Box 2040, Rotterdam, 3015, CN, The Netherlands
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Chadaeva IV, Ponomarenko PM, Rasskazov DA, Sharypova EB, Kashina EV, Zhechev DA, Drachkova IA, Arkova OV, Savinkova LK, Ponomarenko MP, Kolchanov NA, Osadchuk LV, Osadchuk AV. Candidate SNP markers of reproductive potential are predicted by a significant change in the affinity of TATA-binding protein for human gene promoters. BMC Genomics 2018; 19:0. [PMID: 29504899 PMCID: PMC5836831 DOI: 10.1186/s12864-018-4478-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The progress of medicine, science, technology, education, and culture improves, year by year, quality of life and life expectancy of the populace. The modern human has a chance to further improve the quality and duration of his/her life and the lives of his/her loved ones by bringing their lifestyle in line with their sequenced individual genomes. With this in mind, one of genome-based developments at the junction of personalized medicine and bioinformatics will be considered in this work, where we used two Web services: (i) SNP_TATA_Comparator to search for alleles with a single nucleotide polymorphism (SNP) that alters the affinity of TATA-binding protein (TBP) for the TATA boxes of human gene promoters and (ii) PubMed to look for retrospective clinical reviews on changes in physiological indicators of reproductive potential in carriers of these alleles. RESULTS A total of 126 SNP markers of female reproductive potential, capable of altering the affinity of TBP for gene promoters, were found using the two above-mentioned Web services. For example, 10 candidate SNP markers of thrombosis (e.g., rs563763767) can cause overproduction of coagulation inducers. In pregnant women, Hughes syndrome provokes thrombosis with a fatal outcome although this syndrome can be diagnosed and eliminated even at the earliest stages of its development. Thus, in women carrying any of the above SNPs, preventive treatment of this syndrome before a planned pregnancy can reduce the risk of death. Similarly, seven SNP markers predicted here (e.g., rs774688955) can elevate the risk of myocardial infarction. In line with Bowles' lifespan theory, women carrying any of these SNPs may modify their lifestyle to improve their longevity if they can take under advisement that risks of myocardial infarction increase with age of the mother, total number of pregnancies, in multiple pregnancies, pregnancies under the age of 20, hypertension, preeclampsia, menstrual cycle irregularity, and in women smokers. CONCLUSIONS According to Bowles' lifespan theory-which links reproductive potential, quality of life, and life expectancy-the above information was compiled for those who would like to reduce risks of diseases corresponding to alleles in own sequenced genomes. Candidate SNP markers can focus the clinical analysis of unannotated SNPs, after which they may become useful for people who would like to bring their lifestyle in line with their sequenced individual genomes.
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Affiliation(s)
- Irina V Chadaeva
- Brain Neurobiology and Neurogenetics Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
- Novosibirsk State University, Novosibirsk, 630090, Russia
| | | | - Dmitry A Rasskazov
- Brain Neurobiology and Neurogenetics Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
| | - Ekaterina B Sharypova
- Brain Neurobiology and Neurogenetics Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
| | - Elena V Kashina
- Brain Neurobiology and Neurogenetics Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
| | - Dmitry A Zhechev
- Brain Neurobiology and Neurogenetics Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
| | - Irina A Drachkova
- Brain Neurobiology and Neurogenetics Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
| | - Olga V Arkova
- Brain Neurobiology and Neurogenetics Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
- Vector-Best Inc., Koltsovo, Novosibirsk Region, 630559, Russia
| | - Ludmila K Savinkova
- Brain Neurobiology and Neurogenetics Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
| | - Mikhail P Ponomarenko
- Brain Neurobiology and Neurogenetics Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia.
- Novosibirsk State University, Novosibirsk, 630090, Russia.
| | - Nikolay A Kolchanov
- Brain Neurobiology and Neurogenetics Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
- Novosibirsk State University, Novosibirsk, 630090, Russia
| | - Ludmila V Osadchuk
- Brain Neurobiology and Neurogenetics Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
- Novosibirsk State Agricultural University, Novosibirsk, 630039, Russia
| | - Alexandr V Osadchuk
- Brain Neurobiology and Neurogenetics Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
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Breast cancer screening of pregnant and breastfeeding women with BRCA mutations. Breast Cancer Res Treat 2017; 162:225-230. [DOI: 10.1007/s10549-017-4122-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
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20
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Bambara AT, Zamané H, Sawadogo YA, Bambara HA, Mien A, Zongo N, Diallo AA, Ouédraogo A, Traoré SS. Chemotherapy Induced Amenorrhea in Women Treated with Chemotherapy for Breast Carcinoma in Yalgado Ouédraogo Teaching Hospital in Ouagadougou, Burkina Faso. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojog.2017.71014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The health benefits of breastfeeding for babies and mothers have long been recognised and it is now globally recommended that it be continued exclusively for six months. Although there are few controlled trials to support this recommendation, the most important advantage is less morbidity from gastrointestinal infection in developing countries. There is also evidence that respiratory tract infections and atopic dermatitis is reduced, and the maternal risk of breast cancer decreases, particularly with a longer duration of breastfeeding and a high parity. There is little to suggest that exclusive breastfeeding for six months adversely affects infant growth, nutritional status or infant feeding skills, but more studies are needed. Equally, there is no evidence that introduction of solids from 17 weeks is harmful in developed countries. However, in the UK breastfeeding prevalence is low and solids are introduced early for the majority of infants and much can be done to positively encourage and support all mothers to continue breastfeeding for a longer period.
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Affiliation(s)
- A MacDonald
- Dietetic Department, Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, England
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22
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Bleyer A. Screening Mammography: Update and Review of Publications Since Our Report in the New England Journal of Medicine on the Magnitude of the Problem in the United States. Acad Radiol 2016; 23:119-23. [PMID: 26548853 DOI: 10.1016/j.acra.2015.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 12/29/2022]
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Ribnikar D, Ribeiro JM, Pinto D, Sousa B, Pinto AC, Gomes E, Moser EC, Cardoso MJ, Cardoso F. Breast cancer under age 40: a different approach. Curr Treat Options Oncol 2015; 16:16. [PMID: 25796377 DOI: 10.1007/s11864-015-0334-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Breast cancer (BC) under age 40 is a complex disease to manage due to the additionally fertility-related factors to be taken in consideration. More than 90% of young patients with BC are symptomatic. Women<40 years are more likely to develop BC with worse clinicopathological features and more aggressive subtype. This has been frequently associated with inferior outcomes. Recently, the prognostic significance of age<40 has been shown to differ according to the BC subtype, being associated with worst recurrence-free survival (RFS) and overall survival (OS) for luminal BC. The biology of BC<40 has also been explored through analysis of large genomic data set, and specific pathways overexpressed in these tumors have been identified which can lead to the development of targeted therapy in the future. A multidisciplinary tumor board should determine the optimal locoregional and systemic management strategies for every individual patient with BC before the start of any therapy including surgery. This applies to both early (early breast cancer (EBC)) and advanced (advanced breast cancer (ABC)) disease, before the start of any therapy. Mastectomy even in young patients confers no overall survival advantage when compared to breast-conserving treatment (BCT), followed by radiotherapy. Regarding axillary approach, indications are identical to other age groups. Young age is one of the most important risk factors for local recurrence after both breast-conserving surgery (BCS) and mastectomy, associated with a higher risk of distant metastasis and death. Radiation after BCS reduces local recurrence from 19.5 to 10.2% in BC patients 40 years and younger. The indications for and the choice of systemic treatment for invasive BC (both early and advanced disease) should not be based on age alone but driven by the biological characteristics of the individual tumor (including hormone receptor status, human epidermal growth factor receptor 2 (HER-2) status, grade, and proliferative activity), disease stage, and patient's comorbidities. Recommendations regarding the use of genomic profiles such as MammaPrint, Oncotype Dx, and Genomic grade index in young women are similar to the general BC population. Especially in the metastatic setting, patient preferences should always be taken into account, as the disease is incurable. The best strategy for these patients is the inclusion into well-designed, independent, prospective randomized clinical trials. Metastatic disease should always be biopsied whenever feasible for histological confirmation and reassessment of biology. Endocrine therapy is the preferred option for hormone receptor-positive disease (HR+ve), even in presence of visceral metastases, unless there is concern or proof of endocrine resistance or there is a need for rapid disease response and/or symptom control. Recommendations for chemotherapy (CT) should not differ from those for older patients with the same characteristics of the metastatic disease and its extent. Young age by itself should not be an indication to prescribe more intensive and combination CT regimens over the sequential use of monotherapy. Poly(ADP-ribose) polymerase inhibitors (PARP inhibitors) represent an important group of promising drugs in managing patients with breast cancer susceptibility gene (BRCA)-1- or BRCA-2-associated BC. Specific age-related side effects of systemic treatment (e.g., menopausal symptoms, change in body image, bone morbidity, cognitive function impairment, fertility damage, sexual dysfunction) and the social impact of diagnosis and treatment (job discrimination, taking care for children) should also be carefully addressed when planning systemic long-lasting therapy, such as endocrine therapy. Survivorship concerns for young women are different compared to older women, including issues of fertility, preservation, and pregnancy.
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Affiliation(s)
- D Ribnikar
- Medical Oncology Department, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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25
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Margulies AL, Selleret L, Zilberman S, Nagarra IT, Chopier J, Gligorov J, Berveiller P, Ballester M, Darai E, Chabbert-Buffet N. [Pregnancy after cancer: for whom and when?]. Bull Cancer 2015; 102:463-9. [PMID: 25917345 DOI: 10.1016/j.bulcan.2015.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/04/2015] [Indexed: 11/18/2022]
Abstract
Planning a pregnancy for patients with a history of cancer, including breast cancer, is a clinical situation that becomes more and more common. Several specific items are to be discussed: decrease of fertility after cancer treatment, fertility preservation options, impact of pregnancy on cancer recurrence risk and appropriate interval between cancer and pregnancy. Programming pregnancy after cancer is doable in a multidisciplinary setting, and begins at cancer diagnosis to anticipate the various specific pitfalls. Favor adequate oncologic care remains the leading rule.
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Affiliation(s)
- Anne Laure Margulies
- AP-HP, hôpital Bichat, département de gynécologie obstétrique médecine de la reproduction, 75018 Paris, France
| | - Lise Selleret
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, département de gynécologie obstétrique médecine de la reproduction, 75020 Paris, France; Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France
| | - Sonia Zilberman
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, département de gynécologie obstétrique médecine de la reproduction, 75020 Paris, France; Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France
| | | | | | - Joseph Gligorov
- Hôpital Tenon, service d'oncologie médicale, 75020 Paris, France
| | - Paul Berveiller
- Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France; AP-HP, hôpital Trousseau, département de gynécologie obstétrique, 75012 Paris, France
| | - Marcos Ballester
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, département de gynécologie obstétrique médecine de la reproduction, 75020 Paris, France; Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, UMRS-938, 75005 Paris, France
| | - Emile Darai
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, département de gynécologie obstétrique médecine de la reproduction, 75020 Paris, France; Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, UMRS-938, 75005 Paris, France
| | - Nathalie Chabbert-Buffet
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, département de gynécologie obstétrique médecine de la reproduction, 75020 Paris, France; Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, UMRS-938, 75005 Paris, France.
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26
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Hoshi M, Takami M, Ieguchi M, Aono M, Takada J, Oebisu N, Iwai T, Nakamura H. Fertility following treatment of high-grade malignant bone and soft tissue tumors in young adults. Mol Clin Oncol 2015; 3:367-374. [PMID: 25798269 DOI: 10.3892/mco.2014.474] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/18/2014] [Indexed: 11/06/2022] Open
Abstract
This study was conducted to investigate marriage and fertility in long-term survivors with high-grade bone and soft tissue tumors following chemotherapy. We reviewed issues related to fertility in 47 patients (24 men and 23 women) who had survived for >5 years. The median age at diagnosis was 18.0±8.9 years and the mean duration of follow-up 11.0 years. We investigated the proportions of married subjects (number of married/total number of subjects) and fertile subjects (number who had fathered or conceived offspring/total number of subjects), the interval between first delivery and last chemotherapy, type of delivery, congenital deformities in the offspring and the association between cumulative dose of chemotherapeutic agents and subsequent reproduction. The final proportions of married and fertile subjects following sarcoma treatment were 36.2% (17/47) and 29.8% (14/47), respectively. Two subjects had fathered and 8 had conceived a total of 15 offspring. The proportion of fertile men was significantly lower compared to that of women. The mean interval between the last chemotherapy and the first delivery was 9.5 years. Of the 10 first births, 6 were normal transvaginal deliveries and 4 were caesarean sections (1 was a medical termination due to lung metastases, 1 was due to infected amniotic fluid caused by uterine myomas and 2 were performed due to abnormal rotation of the fetus). No offspring presented with congenital deformities. Fertile men had received smaller cumulative chemotherapeutic agent doses, particularly of ifosfamide, compared to those who had not fathered any offspring. In conclusion, infertility occurs more frequently in men compared to women following intensive chemotherapy. All the patients should be offered counseling regarding the potential risk of infertility prior to cancer treatment.
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Affiliation(s)
- Manabu Hoshi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Masatsugu Takami
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Makoto Ieguchi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Masanari Aono
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Jun Takada
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Naoto Oebisu
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Tadashi Iwai
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
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27
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Bleyer A. Were our estimates of overdiagnosis with mammography screening in the United States "based on faulty science"? Oncologist 2014; 19:113-26. [PMID: 24536052 DOI: 10.1634/theoncologist.2013-0383] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Archie Bleyer
- St. Charles Health System, Central Oregon, Oregon Health and Science University, Portland, Oregon, USA
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28
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Patel A, Roston A, Uy A, Radeke E, Roston A, Keith L, Zaren HA. Reproductive health and endocrine disruption in women with breast cancer: a pilot study. Support Care Cancer 2014; 23:411-8. [PMID: 25120011 DOI: 10.1007/s00520-014-2381-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 07/31/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to assess whether incorporation of an original reproductive health assessment and algorithm into breast cancer care helps providers appropriately manage patient reproductive health goals and to follow laboratory markers for fertility and correlate these with menstruation. METHODS This prospective observational pilot study was set in an urban, public hospital. Newly diagnosed premenopausal breast cancer patients between 18 and 49 years old were recruited for this study prior to chemotherapy initiation. As the intervention, these patients received a reproductive health assessment and care per the study algorithm at 3-month intervals for 24 months. Blood samples were also collected at the same time intervals. The main outcome measures were to assess if the reproductive health management was consistent with patient goals and to track any follicle-stimulating hormone (FSH) and thyroid-stimulating hormone (TSH) level changes throughout treatment and post-treatment period. RESULTS Two patients were pregnant at study initiation. They received obstetric consultations, opted to continue pregnancies, and postpone treatment; both delivered at term without complications. One woman desired future childbearing and received fertility preservation counseling. All women received family planning consultations and received/continued effective contraceptive methods. Seventy-three percent used long-term contraception, 18 % remained abstinent, and 9 % used condoms. During chemotherapy, FSH rose to menopausal levels in 82 % of patients and TSH rose significantly in 9 %. While 82 % of women experienced amenorrhea, 44 % of these women resumed menstruation after chemotherapy. CONCLUSIONS The assessment and algorithm were useful in managing patients' reproductive health needs. Chemotherapy-induced endocrine disruption impacted reproductive health.
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Affiliation(s)
- Ashlesha Patel
- Division of Family Planning, Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, 1900 W. Polk St., Room #435, Chicago, IL, 60612, USA,
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29
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Brasky TM, Li Y, Jaworowicz DJ, Potischman N, Ambrosone CB, Hutson AD, Nie J, Shields PG, Trevisan M, Rudra CB, Edge SB, Freudenheim JL. Pregnancy-related characteristics and breast cancer risk. Cancer Causes Control 2013; 24:1675-85. [PMID: 23737027 PMCID: PMC3737361 DOI: 10.1007/s10552-013-0242-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 05/25/2013] [Indexed: 12/21/2022]
Abstract
Breast tissues undergo extensive physiologic changes during pregnancy, which may affect breast carcinogenesis. Gestational hypertension, preeclampsia/eclampsia, gestational diabetes, pregnancy weight gain, and nausea and vomiting (N&V) during pregnancy may be indicative of altered hormonal and metabolic profiles and could impact breast cancer risk. Here, we examined associations between these characteristics of a woman's pregnancy and her subsequent breast cancer risk. Participants were parous women that were recruited to a population-based case-control study (Western New York Exposures and Breast Cancer Study). Cases (n = 960), aged 35-79 years, had incident, primary, histologically confirmed breast cancer. Controls (n = 1,852) were randomly selected from motor vehicle records (< 65 years) or Medicare rolls (≥ 65 years). Women were queried on their lifetime pregnancy experiences. Multivariable-adjusted logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). N&V during pregnancy was inversely associated with breast cancer risk. Relative to those who never experienced N&V, ever experiencing N&V was associated with decreased risk (OR 0.69, 95% CI 0.56-0.84) as were increased N&V severity (p trend < 0.001), longer duration (p trend < 0.01), and larger proportion of affected pregnancies (p trend < 0.0001) among women with ≥ 3 pregnancies. Associations were stronger for more recent pregnancies (< 5 years). Findings did not differ by menopausal status or breast cancer subtype including estrogen receptor and HER2 expression status. Other pregnancy characteristics examined were not associated with risk. We observed strong inverse associations between pregnancy N&V and breast cancer risk. Replication of these findings and exploration of underlying mechanisms could provide important insight into breast cancer etiology and prevention.
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Affiliation(s)
- Theodore M Brasky
- Division of Cancer Prevention and Control, The Ohio State University College of Medicine, Columbus, OH, USA.
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Rafi I, Chowdhury S, Chan T, Jubber I, Tahir M, de Lusignan S. Improving the management of people with a family history of breast cancer in primary care: before and after study of audit-based education. BMC FAMILY PRACTICE 2013; 14:105. [PMID: 23879178 PMCID: PMC3734209 DOI: 10.1186/1471-2296-14-105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 07/08/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND In England, guidance from National Institute for Clinical Excellence (NICE) states women with a family history of breast cancer presenting to primary care should be reassured or referred.We reviewed the evidence for interventions that might be applied in primary care and conducted an audit of whether low risk women are correctly advised and flagged. METHODS We conducted a literature review to identify modifiable risk factors. We extracted routinely collected data from the computerised medical record systems of 6 general practices (population approximately 30,000); of the variables identified in the guidance. We implemented a quality improvement (QI) intervention called audit-based education (ABE) comparing participant practices with guidelines and each other before and after; we report odds ratios (OR) of any change in data recording. RESULTS The review revealed evidence for advising on: diet, weight control, physical exercise, and alcohol. The proportion of patients with recordings of family history of: disease, neoplasms, and breast cancer were: 39.3%, 5.1% and 1.3% respectively. There was no significant change in the recording of family history of disease or cancer; OR 1.02 (95% CI 0.98-1.06); and 1.08 (95% CI 0.99-1.17) respectively. Recording of alcohol consumption and smoking both increased significantly; OR 1.36 (95% CI 1.30-1.43); and 1.42 (95% CI 1.27-1.60) respectively. Recording lifestyle advice fell; OR 0.84 (95% CI 0.81-0.88). CONCLUSIONS The study informs about current data recording and willingness to engage in ABE. Recording of risk factors improved after the intervention. Further QI is needed to achieve adherence to current guidance.
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Affiliation(s)
- Imran Rafi
- Division of Population Health Sciences and Education, St George’s, University of London, Cranmer Terrace, London SW17 0RE, UK
- Clinical Innovation and Research Centre (CIRC), Royal College of General Practitioners, 30 Euston Square, London NW1 2FB, UK
| | - Susmita Chowdhury
- PHG Foundation, 2 Worts Causeway, Cambridge, Cambridgeshire CB1 8RN, UK
| | - Tom Chan
- Department of Healthcare Management and Policy, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - Ibrahim Jubber
- Division of Population Health Sciences and Education, St George’s, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Mohammad Tahir
- Department of Healthcare Management and Policy, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - Simon de Lusignan
- Department of Healthcare Management and Policy, University of Surrey, Guildford, Surrey GU2 7XH, UK
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Hou N, Ogundiran T, Ojengbede O, Morhason-Bello I, Zheng Y, Fackenthal J, Adebamowo C, Anetor I, Akinleye S, Olopade OI, Huo D. Risk factors for pregnancy-associated breast cancer: a report from the Nigerian Breast Cancer Study. Ann Epidemiol 2013; 23:551-7. [PMID: 23880155 DOI: 10.1016/j.annepidem.2013.06.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 05/17/2013] [Accepted: 06/11/2013] [Indexed: 12/29/2022]
Abstract
PURPOSE Little is known about risk factors for pregnancy-associated breast cancer (PABC), diagnosed during pregnancy or postpartum. METHODS We enrolled 1715 premenopausal women from the Nigerian Breast Cancer Study from 1998 to 2011. Based on recency of last pregnancy from diagnosis, breast cancer cases were categorized as (1) PABC diagnosed 2 years or longer postpartum, (2) PABC diagnosed 3 to 5 years postpartum, or (3) non-PABC diagnosed more than 5 years postpartum. Controls were matched to cases on recency of last pregnancy. Multiple logistic regressions were performed comparing cases and controls within each group. RESULTS Of the 718 cases, 152 (21.2%) had PABC 2 or more years postpartum, and 145 (20.2%) 3 to 5 years postpartum. Although not statistically significant, women with higher parity tend to have an elevated risk of PABC but reduced risk of non-PABC (p for heterogeneity = 0.097). Family history of breast cancer might be a strong predictor particularly for PABC 2 or more years postpartum (odds ratio, 3.28; 95% confidence interval, 1.05-10.3). Compared with non-PABC cases, PABC 2 or more years postpartum cases were more likely to carry BRCA1/2 mutations (P = .03). CONCLUSIONS Parity may have different roles in the development of PABC versus other premenopausal breast cancer in Nigerian women. Prospective mothers with multiple births and a family history of breast cancer may have an elevated risk of breast cancer during their immediate postpartum period.
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Affiliation(s)
- Ningqi Hou
- Department of Health Studies, University of Chicago, IL, USA
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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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Comtet M, Chabbert-Buffet N. Contraception après cancer: balance bénéfice/risque pour une contraception adaptée et acceptée. ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2277-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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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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Groen RS, Bae JY, Lim KJ. Fear of the unknown: ionizing radiation exposure during pregnancy. Am J Obstet Gynecol 2012; 206:456-62. [PMID: 22244469 DOI: 10.1016/j.ajog.2011.12.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 10/18/2011] [Accepted: 12/06/2011] [Indexed: 11/18/2022]
Abstract
Ionizing radiation during pregnancy can negatively impact a fetus. In light of the Fukushima nuclear plant disaster in Japan, we discuss existing knowledge on the health effects of radiation and preventive measures for pregnant women. Overall, the risk of exposure to radiation is limited but severe defects can result from fetal radiation exposure >100 mGy equivalent to 10 rad (>1000 chest x-rays). While such high-level exposure rarely occurs during single medical diagnostic procedures, caution should be exercised for pregnant women. As a protective public health measure in light of a disaster, evacuation, shielding, and elimination of ingested radioactive isotopes should all be considered. Detailed radiation reports with health effects and precautionary measures should be available for a population exposed to more than background radiation.
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Hughes K, Wickenden JA, Allen JE, Watson CJ. Conditional deletion of Stat3 in mammary epithelium impairs the acute phase response and modulates immune cell numbers during post-lactational regression. J Pathol 2012; 227:106-17. [PMID: 22081431 PMCID: PMC3477635 DOI: 10.1002/path.3961] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 10/04/2011] [Accepted: 10/31/2011] [Indexed: 12/31/2022]
Abstract
Mammary gland regression following weaning (involution) is associated with extensive cell death and the acquisition of an inflammatory signature. Characterizing the interplay between mammary epithelial cells, the re-emerging stroma and immune cells has implications for the understanding of the pathogenesis of pregnancy-associated breast cancer. Stat3 has a role in orchestrating cell death and involution, and we sought to determine whether expression of Stat3 by the mammary epithelium also influences the innate immune environment and inflammatory cell influx in the gland. We examined mice in which Stat3 is conditionally deleted only in the mammary epithelium. Distinct sets of genes associated with the acute phase response and innate immunity are markedly up-regulated during first phase involution in a Stat3-dependent manner. During second phase involution, chitinase 3-like 1, which has been associated with wound healing and chronic inflammatory conditions, is dramatically up-regulated by Stat3. Also at this time, the number of mammary macrophages and mast cells increases per unit area, and this increase is impaired in the absence of epithelial Stat3. Furthermore, expression of arginase-1 and Ym1, markers of alternatively activated macrophages, is significantly decreased in the absence of Stat3, whilst iNOS, a marker associated with classically activated macrophages, shows significantly increased expression in the Stat3-deleted glands. Thus, Stat3 is a key transcriptional regulator of genes associated with innate immunity and wound healing and influences mammary macrophage and mast cell numbers. The presence of epithelial Stat3 appears to polarize the macrophages and epithelial cells towards an alternatively activated phenotype, since in the absence of Stat3, the gland retains a phenotype associated with classically activated macrophages. These findings have relevance to the study of pregnancy-associated breast cancer and the role of Stat3 signalling in recruitment of alternatively activated tumour-associated macrophages in breast cancer. Copyright © 2012 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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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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Hartmann S, Reimer T, Gerber B. Management of early invasive breast cancer in very young women (<35 years). Clin Breast Cancer 2011; 11:196-203. [PMID: 21752723 DOI: 10.1016/j.clbc.2011.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 11/19/2010] [Accepted: 11/21/2010] [Indexed: 01/19/2023]
Abstract
BACKGROUND To give an overview about current treatment recommendations and special problems concerning the management of women <35 years with early breast cancer. METHODS We performed a selective systematic literature review. We discussed with reference to key studies and meta-analyses, current standards of care, and controversies regarding patient management. RESULTS Breast cancer in patients younger than 35 years is rare but associated with an unsatisfactory prognosis. Local treatment should not differ from general guidelines, but awareness of the high risk of local recurrence must be maintained. Adjuvant polychemotherapy is almost always indicated, standard endocrine therapy is tamoxifen. Before the start of systemic therapy, the patient must be offered different types of fertility preservation. Pregnancy related breast cancer is not associated with a worse prognosis, but with delayed diagnosis. Therefore, every suspicious lesion in the breast or axilla must be imaged and biopsied. The optimal time to delay pregnancy following the diagnosis is unknown. Hormonal contraceptives are contraindicated after breast cancer. Every woman <35 years diagnosed with breast cancer should be offered genetic counseling. CONCLUSION The management of breast cancer in very young women requires a multidisciplinary team to find the optimal treatment and to solve their specific problems.
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Affiliation(s)
- Steffi Hartmann
- Department of Obstetrics and Gynecology, University of Rostock, Südring 81, Rostock, Germany.
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40
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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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Lawrenz B, Banys M, Henes M, Neunhoeffer E, Grischke EM, Fehm T. Pregnancy after breast cancer: case report and review of the literature. Arch Gynecol Obstet 2011; 283:837-43. [PMID: 21221981 DOI: 10.1007/s00404-010-1829-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 12/21/2010] [Indexed: 12/28/2022]
Abstract
Despite breast cancer diagnosis and treatment, women of childbearing age often desire a pregnancy. Since the average age of women giving birth for the first time is increasing, many young patients diagnosed with breast cancer have not started or completed their family planning. Thus, gynecologists and oncologists are confronted more often with the question of childbearing after breast cancer. Current data from retrospective trials do not suggest an increased risk of a recurrence or progress of the disease associated with pregnancy after stage-adjusted treatment. Also, the risk of fetal malformations and damage to the fetus after chemotherapy and/or hormone therapy seems similar to that in the general population. Women who receive chemotherapy are advised to wait at least 6 months before they attempt to conceive. The question whether to become pregnant must be discussed individually with the patient, based on tumor characteristics, stage of the disease and patient's wishes.
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Affiliation(s)
- Barbara Lawrenz
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstrasse 7, 72076 Tuebingen, Germany
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Wong CM, Anderton DL, Smith-Schneider S, Wing MA, Greven MC, Arcaro KF. Quantitative analysis of promoter methylation in exfoliated epithelial cells isolated from breast milk of healthy women. Epigenetics 2010; 5:645-55. [PMID: 20716965 DOI: 10.4161/epi.5.7.12961] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Promoter methylation analysis of genes frequently silenced in breast cancer is a promising indicator of breast cancer risk, as these methylation events are thought to occur long before presentation of disease. The numerous exfoliated epithelial cells present in breast milk may provide the breast epithelial DNA needed for detailed methylation analysis and assessment of breast cancer risk. Fresh breast milk samples and health, lifestyle, and reproductive history questionnaires were collected from 111 women. Pyrosequencing analysis was conducted on DNA isolated from the exfoliated epithelial cells immunomagnetically separated from the total cell population in the breast milk of 102 women. A total of 65 CpG sites were examined in six tumor suppressor genes: PYCARD (also known as ASC or TMS1), CDH1, GSTP1, RBP1 (also known as CRBP1), SFRP1, and RASSF1. A sufficient quantity of DNA was obtained for meaningful analysis of promoter methylation; women donated an average of 86 ml of milk with a mean yield of 32,700 epithelial cells per ml. Methylation scores were in general low as expected of benign tissue, but analysis of outlier methylation scores revealed a significant relationship between breast cancer risk, as indicated by previous biopsy, and methylation score for several CpG sites in CDH1, GSTP1, SFRP1, and RBP1. Methylation of RASSF1 was positively correlated with women's age irrespective of her reproductive history. Promoter methylation patterns in DNA from breast milk epithelial cells can likely be used to assess breast cancer risk. Additional studies of women at high breast cancer risk are warranted.
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Affiliation(s)
- Chung M Wong
- Department of Veterinary & Animal Science, University of Massachusetts at Amherst, MA, USA
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Mathelin C, Gairard B, Croce S. Cancer du sein : impact sur le désir de grossesse. IMAGERIE DE LA FEMME 2009. [DOI: 10.1016/j.femme.2009.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ulery M, Carter L, McFarlin BL, Giurgescu C. Pregnancy-associated breast cancer: significance of early detection. J Midwifery Womens Health 2009; 54:357-363. [PMID: 19720336 DOI: 10.1016/j.jmwh.2008.12.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 12/17/2008] [Accepted: 12/17/2008] [Indexed: 11/27/2022]
Abstract
Pregnancy-associated breast cancer (PABC) is defined as cancer of the breast diagnosed during pregnancy and up to 1 year postpartum. Delays in diagnosis are frequently associated with increased morbidity and mortality. The aim of this article is to determine the significance of early detection of PABC and to alert health care providers to include PABC in the differential diagnosis when evaluating a breast mass in the perinatal period. This integrative literature review evaluated 15 research studies by using the hypothetical deductive model of clinical reasoning to determine factors related to diagnosis of PABC. As women delay childbearing, the incidence of PABC increases with age. In the reviewed studies, breast cancer was diagnosed with greater frequency in the postpartum period than during any trimester in pregnancy. Delay in diagnosis is complicated by axillary lymph node metastasis, high-grade tumors at diagnosis, and poor outcomes. Early detection is a significant predictor of improved outcomes. Diagnostic modalities such as ultrasound, mammography, and biopsy can be safely used for diagnostic purposes in the evaluation of potential cases of PABC during pregnancy.
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Affiliation(s)
- MaryAnn Ulery
- MaryAnn Ulery, APN, WHNP-BC, MS, is a women's health nurse practitioner, employed at Woman To Woman Obstetrics and Gynecology, P.C. in Crystal Lake, Illinois.Linnette Carter, APN, CNS, MS, is a perinatal clinical nurse specialist at Rockford Memorial Hospital, Northwestern Illinois Perinatal Network.Barbara L. McFarlin, CNM, RDMS, PhD, is a research assistant professor at the University of Illinois at Chicago College of Nursing.Carmen Giurgescu, RN, WHNP, PhD, is an assistant professor at the University of Illinois at Chicago College of Nursing
| | - Linnette Carter
- MaryAnn Ulery, APN, WHNP-BC, MS, is a women's health nurse practitioner, employed at Woman To Woman Obstetrics and Gynecology, P.C. in Crystal Lake, Illinois.Linnette Carter, APN, CNS, MS, is a perinatal clinical nurse specialist at Rockford Memorial Hospital, Northwestern Illinois Perinatal Network.Barbara L. McFarlin, CNM, RDMS, PhD, is a research assistant professor at the University of Illinois at Chicago College of Nursing.Carmen Giurgescu, RN, WHNP, PhD, is an assistant professor at the University of Illinois at Chicago College of Nursing
| | - Barbara L McFarlin
- MaryAnn Ulery, APN, WHNP-BC, MS, is a women's health nurse practitioner, employed at Woman To Woman Obstetrics and Gynecology, P.C. in Crystal Lake, Illinois.Linnette Carter, APN, CNS, MS, is a perinatal clinical nurse specialist at Rockford Memorial Hospital, Northwestern Illinois Perinatal Network.Barbara L. McFarlin, CNM, RDMS, PhD, is a research assistant professor at the University of Illinois at Chicago College of Nursing.Carmen Giurgescu, RN, WHNP, PhD, is an assistant professor at the University of Illinois at Chicago College of Nursing
| | - Carmen Giurgescu
- MaryAnn Ulery, APN, WHNP-BC, MS, is a women's health nurse practitioner, employed at Woman To Woman Obstetrics and Gynecology, P.C. in Crystal Lake, Illinois.Linnette Carter, APN, CNS, MS, is a perinatal clinical nurse specialist at Rockford Memorial Hospital, Northwestern Illinois Perinatal Network.Barbara L. McFarlin, CNM, RDMS, PhD, is a research assistant professor at the University of Illinois at Chicago College of Nursing.Carmen Giurgescu, RN, WHNP, PhD, is an assistant professor at the University of Illinois at Chicago College of Nursing
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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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Affiliation(s)
- Kristin L Cox
- Virginia Clinton Kelley/FFANY Breast Fellowship, Komen Interdisciplinary Breast Fellowship, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Hickey M, Peate M, Saunders CM, Friedlander M. Breast cancer in young women and its impact on reproductive function. Hum Reprod Update 2009; 15:323-39. [PMID: 19174449 PMCID: PMC2667113 DOI: 10.1093/humupd/dmn064] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 11/28/2008] [Accepted: 12/30/2008] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Breast cancer is the most common cancer in women in developed countries, and 12% of breast cancer occurs in women 20-34 years. Survival from breast cancer has significantly improved, and the potential late effects of treatment and the impact on quality of life have become increasingly important. Young women constitute a minority of breast cancer patients, but commonly have distinct concerns and issues compared with older women, including queries regarding fertility, contraception and pregnancy. Further, they are more likely than older women to have questions regarding potential side effects of therapy and risk of relapse or a new primary. In addition, many will have symptoms associated with treatment and they present a management challenge. Reproductive medicine specialists and gynaecologists commonly see these women either shortly after initial diagnosis or following adjuvant therapy and should be aware of current management of breast cancer, the options for women at increased genetic risk, the prognosis of patients with early stage breast cancer and how adjuvant systemic treatments may impact reproductive function. METHODS No systematic literature search was done. The review focuses on the current management of breast cancer in young women and the impact of treatment on reproductive function and subsequent management. With reference to key studies and meta-analyses, we highlight controversies and current unanswered questions regarding patient management. RESULTS Chemotherapy for breast cancer is likely to negatively impact on reproductive function. A number of interventions are available which may increase the likelihood of future successful pregnancy, but the relative safety of these interventions is not well established. For those who do conceive following breast cancer, there is no good evidence that pregnancy is detrimental to survival. We review current treatment; effects on reproductive function; preservation of fertility; contraception; pregnancy; breastfeeding and management of menopausal symptoms following breast cancer. CONCLUSION This paper provides an update on the management of breast cancer in young women and is targeted at reproductive medicine specialists and gynaecologists.
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Affiliation(s)
- M Hickey
- School of Women's and Infants' Health, University of Western Australia, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, WA 6008, Australia.
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Lenhard MS, Bauerfeind I, Untch M. Breast cancer and pregnancy: Challenges of chemotherapy. Crit Rev Oncol Hematol 2008; 67:196-203. [DOI: 10.1016/j.critrevonc.2008.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 02/05/2008] [Accepted: 02/21/2008] [Indexed: 11/17/2022] Open
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Abstract
OBJECTIVE To compare stage distribution, tumor characteristics, and survival outcome in pregnancy-associated and non-pregnancy-associated breast cancer, and to evaluate pregnancy as a risk factor for mortality in breast cancer. METHODS The California Cancer Registry (1991-1999) was linked with the California Patient Discharge Data Set to identify women with breast cancer occurring within 9 months before or 1 year after an obstetric delivery. Age-matched, non-pregnancy-associated breast cancer controls were also identified. Demographics, cancer stage, tumor size, histology, hormone receptor status, type of treatment, and survival were reviewed and compared. Predictive factors for death from breast cancer were identified using proportional hazards modeling. RESULTS Seven hundred ninety-seven pregnancy-associated breast cancer cases were compared with 4,177 non-pregnancy-associated breast cancer controls. Pregnancy-associated breast cancer cases were significantly more likely to have more advanced stage, larger primary tumor, hormone receptor negative tumor, and mastectomy as a component of their treatment. In survival analysis, pregnancy-associated breast cancer had a higher death rate than non-pregnancy-associated breast cancer (39.2% compared with 33.4%, P=.002). In a multivariable analysis, advancing stage (2.22-10.76 times the risk of death for stages II-IV), race (African Americans had 68% increased risk of death over non-Hispanic whites), hormone receptor-negative tumors (20% increased risk of death over receptor-positive tumors), and pregnancy (14% increased risk of death over nonpregnant women) all were significant predictors of death. CONCLUSION Pregnancy-associated breast cancer presented with more advanced disease, larger tumors, and increased percentage of hormone receptor-negative tumors. When controlled for stage, race, and hormone receptor status, pregnancy-associated breast cancer cases had a slightly higher risk of death, even when only localized-stage disease was considered. LEVEL OF EVIDENCE II.
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