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Kim JH, Kim YY, Chung JH, Kim WY, Lee JB, Woo SU. Safe and successful pregnancy following breast cancer treatment in young patients 35 years old or under without invasive fertility preservation: a retrospective study. Ann Surg Treat Res 2024; 106:189-194. [PMID: 38586552 PMCID: PMC10995843 DOI: 10.4174/astr.2024.106.4.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/21/2024] [Accepted: 01/31/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Recent advances in the treatment of breast cancer have led to the improvement of breast cancer patient's survival. With the prolonged survival of these patients, pregnancy became an important issue, especially in young cancer patient aged 35 years or under. Increased hormone levels during pregnancy, however, raise concerns about elevating the risk of cancer recurrence. The aim of this study was to validate the notion of increased risk associated with pregnancy after breast cancer treatment in young patients. Methods From January 2009 to December 2020, newly diagnosed breast cancer patients 35 years old or under who underwent optimal surgery in Korea University Guro Hospital were enrolled in this study. Patients were categorized into 3 groups: nulliparous, pregnancy prior to treatment of breast cancer, and patients with pregnancy after breast cancer treatment. Their overall survival and disease-free survival were evaluated. Results A total of 107 patients were enrolled in this study. Thirteen patients (12.1%) conceived and successfully delivered. The mean follow-up period after surgery was 58.9 (± 33.5) months. There was no significant difference in overall survival (P = 0.608) and disease-free survival (P = 0.591) among different groups. Conclusion In young patients, pregnancy after treatment for breast cancer did not affect their overall survival or diseasefree survival as compared to nullipara or previously delivered groups. Therefore, pregnancy counseling should not be prevented in young breast cancer patients 35 years old or under.
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Affiliation(s)
- Ji Hye Kim
- Department of Breast and Endocrine Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yong Yeup Kim
- Department of Breast and Endocrine Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jai Hyun Chung
- Department of Breast and Endocrine Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo Young Kim
- Department of Breast and Endocrine Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jae Bok Lee
- Department of Breast and Endocrine Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Uk Woo
- Department of Breast and Endocrine Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Margioula-Siarkou G, Margioula-Siarkou C, Petousis S, Vavoulidis E, Margaritis K, Almperis A, Haitoglou C, Mavromatidis G, Dinas K. Breast Carcinogenesis during Pregnancy: Molecular Mechanisms, Maternal and Fetal Adverse Outcomes. BIOLOGY 2023; 12:biology12030408. [PMID: 36979100 PMCID: PMC10045536 DOI: 10.3390/biology12030408] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023]
Abstract
Breast cancer is a common type of cancer diagnosed during pregnancy, with increasing incidence over the last years, as more women choose to delay childbearing. Compared to breast cancer in general population, pregnancy-associated breast cancer (PABC) is significantly different in its terms of epidemiology, diagnostic and therapeutic management, while it exhibits particularly aggressive behavior, deriving from its unique molecular and biological profile. Although not fully elucidated, the pathophysiological basis of PABC can be traced back to a combination of hormonal and immune changes during pregnancy, breast involution and altered gene expression. There is considerable controversy in the existing literature about the influence of PABC on pregnancy outcomes, regarding both short- and long-term effects on maternal and fetal/neonatal health. The majority of PABC patients have advanced-stage disease at initial diagnosis and face a significantly poorer prognosis, with decreased survival rates. The most commonly reported adverse obstetrical–fetal events are preterm delivery and prematurity-associated neonatal morbidity, while other neonatal treatment-associated complications might also occur, even when safe therapeutic options are applied during pregnancy. The objective of the present comprehensive review was to summarize current knowledge and up-to-date evidence about the pathophysiological, molecular and biological basis of PABC, as well as its association with adverse maternal, obstetrical, fetal and neonatal outcomes.
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Affiliation(s)
- Georgia Margioula-Siarkou
- 2nd Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Correspondence:
| | - Chrysoula Margioula-Siarkou
- 2nd Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Stamatios Petousis
- 2nd Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Eleftherios Vavoulidis
- 2nd Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Kosmas Margaritis
- 2nd Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Aristarchos Almperis
- 2nd Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Costas Haitoglou
- Laboratory of Biochemistry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - George Mavromatidis
- 2nd Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Konstantinos Dinas
- 2nd Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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Rauh-Hain JA, Zubizarreta J, Nitecki R, Melamed A, Fu S, Jorgensen K, Brady PC, Baker VL, Chavez-MacGregor M, Giordano SH, Keating NL. Survival outcomes following pregnancy or assisted reproductive technologies after breast cancer: A population-based study. Cancer 2022; 128:3243-3253. [PMID: 35767282 PMCID: PMC9378486 DOI: 10.1002/cncr.34371] [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: 02/24/2022] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study sought to determine the impact of pregnancy or assisted reproductive technologies (ART) on breast-cancer-specific survival among breast cancer survivors. METHODS The authors performed a cohort study using a novel data linkage from the California Cancer Registry, the California birth cohort, and the Society for Assisted Reproductive Technology Clinic Outcome Reporting System data sets. They performed risk-set matching in women with stages I-III breast cancer diagnosed between 2000 and 2012. For each pregnant woman, comparable women who were not pregnant at that point but were otherwise similar based on observed characteristics were matched at the time of pregnancy. After matching, Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of pregnancy with breast-cancer-specific survival. We repeated these analyses for women who received ART. RESULTS Among 30,021 women with breast cancer, 553 had a pregnancy and 189 attempted at least one cycle of ART. In Cox proportional hazards modeling, the pregnancy group had a higher 5-year disease-specific survival rate; 95.6% in the pregnancy group and 90.6% in the nonpregnant group (HR, 0.43; 95% CI, 0.24-0.77). In women with hormone receptor-positive cancer, we found similar results (HR, 0.43; 95% CI, 0.2-0.91). In the ART analysis, there was no difference in survival between groups; the 5-year disease-specific survival rate was 96.9% in the ART group and 94.1% in the non-ART group (HR, 0.44; 95% CI, 0.17-1.13). CONCLUSION Pregnancy and ART are not associated with worse survival in women with breast cancer. LAY SUMMARY We sought to determine the impact of pregnancy or assisted reproductive technologies (ART) among breast cancer survivors. We performed a study of 30,021 women by linking available data from California and the Society for Assisted Reproductive Technology Clinic Outcome Reporting System. For each pregnant woman, we matched at the time of pregnancy comparable women who were not pregnant at that point but were otherwise similar based on observed characteristics. We repeated these analyses for women who received ART. We found that pregnancy and ART were not associated with worse survival.
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Affiliation(s)
- J. Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jose Zubizarreta
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, United States
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Alexander Melamed
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Shuangshuang Fu
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kirsten Jorgensen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Paula C. Brady
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, United States
| | - Valerie L. Baker
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Johns Hopkins University, Baltimore, MD, United States
| | - Mariana Chavez-MacGregor
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sharon H. Giordano
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nancy L. Keating
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
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Li Y, Zhang Y, Wang S, Lu S, Song Y, Liu H. The Effect of Subsequent Pregnancy on Prognosis in Young Breast Cancer Patients (≤35 Years Old) According to Hormone Receptor Status. Cancer Manag Res 2021; 13:1505-1515. [PMID: 33623430 PMCID: PMC7894832 DOI: 10.2147/cmar.s290566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/18/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose We aimed to examine the effect of pregnancy on prognosis in young breast cancer (YBC) patients with hormone receptor (HR) positive after surgery and the safety of interrupting endocrine therapy (ET). Methods A retrospective cohort study was performed in patients who became pregnant after BC surgery under the age of 35 and were matched (1:4) to nonpregnant patients from 2006 to 2014. The primary endpoints were disease-free survival (DFS) and overall survival (OS) in HR-positive BC patients, and the secondary endpoints were DFS and OS in HR-negative BC patients and the whole population. Subgroup analyses included the DFS of patients who became pregnant within 5 years after surgery and DFS according to the ET interval time (≤ 30 months v > 30 months) in the pregnant group. Results A total of 1323 YBC patients were collected in our study, which included 68 pregnant patients and 264 matched nonpregnant patients. There were no statistically significant differences in DFS and OS among HR-positive patients (P=0.657, P=0.250, respectively) and the whole population (P=0.058, P=0.152, respectively). A BC pregnancy interval ≤ 5 years showed a better DFS (P=0.042), and an ET interval ≤ 30 months had a worse DFS (P = 0.01). Conclusion This study did not observe a worse prognosis in patients with HR-positive disease who became pregnant after BC surgery, and an ET interval less than 30 months in pregnant patients led to a worse outcome. Patients were able to become pregnant within 5 years after surgery.
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Affiliation(s)
- Yang Li
- The Second Surgical Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China
| | - Yuhan Zhang
- The Second Surgical Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China
| | - Shuaibing Wang
- Oncology Department, China National Petroleum Corporation Central Hospital, Langfang, Hebei Province, 065000, People's Republic of China
| | - Su Lu
- The Second Surgical Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China
| | - Yixuan Song
- The Second Surgical Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China
| | - Hong Liu
- The Second Surgical Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China
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5
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Lee MH, Kim YA, Hong JH, Jung SY, Lee S, Kong SY, Park B, Lee ES. Outcomes of Pregnancy after Breast Cancer in Korean Women: A Large Cohort Study. Cancer Res Treat 2019; 52:426-437. [PMID: 31476846 PMCID: PMC7176946 DOI: 10.4143/crt.2018.382] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/03/2019] [Indexed: 01/17/2023] Open
Abstract
Purpose The purpose of this study was to determine the rate and outcomes of pregnancies subsequent to breast cancer in Korea, and the effect of such pregnancies on the prognosis of women who survived breast cancer and subsequently conceived. Materials and Methods We followed a total of 31,761 Korean women 45 years of age or younger who were treated for primary breast cancer from 2002 to 2010. We also included follow-up surveys that were conducted through December 2011. We identified recurrence and mortality from breast cancer using data linked to the Korea National Health Insurance database. We used propensity score matching of the study cohort to analyze the risks of recurrence and mortality from breast cancer depending on pregnancy. Results Within our sample, 992 women (3.1%) became pregnant after receiving treatment for breast cancer. Of those, 622 (67.5%) successfully delivered; the remaining 370 (32.5%) failed to deliver. After propensity score matching, we found that the women who became pregnant after breast cancer did not have a different risk of recurrence (hazard ratio [HR], 0.503; 95% confidence interval [CI], 0.434 to 0.584) and death (HR, 0.520; 95% CI, 0.397 to 0.681), compared with those who did not conceive after breast cancer treatment. Conclusion Our study is the first to report outcomes for Korean women who survived breast cancer and subsequently conceived. Women who survived breast cancer and subsequently became pregnant did not show a poorer survival outcome, compared with those who did not become pregnant.
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Affiliation(s)
- Moo Hyun Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Division of Breast and Thyroid, Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Young Ae Kim
- Cancer Survivorship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jin Hyuk Hong
- Cancer Survivorship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - So-Youn Jung
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sunmi Lee
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Korea
| | - Sun-Young Kong
- Department of Laboratory Medicine, Center for Diagnostic Oncology, National Cancer Center, Goyang, Korea.,Graduate School of Cancer Science and Policy, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- Graduate School of Cancer Science and Policy, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Eun Sook Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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6
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Carneiro MM, Cota AM, Amaral MC, Pedrosa ML, Martins BO, Furtado MH, Lamaita RM, Ferreira MCF. Motherhood after breast cancer: can we balance fertility preservation and cancer treatment? A narrative review of the literature. JBRA Assist Reprod 2018; 22:244-252. [PMID: 29932615 PMCID: PMC6106637 DOI: 10.5935/1518-0557.20180032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Breast cancer may affect young women who have not yet completed childbearing.
Assisted reproductive technology (ART) provides alternatives for fertility
preservation such as oocyte, embryo or ovarian tissue cryopreservation. We
reviewed the published literature on fertility-preserving management in breast
cancer, aiming at finding evidence to answer the following questions: (1) What
are the fertility sparing options available?; (2) How do these women respond to
IVF? and (3) Can pregnancy influence breast cancer recurrence? There is a
paucity of publications describing clinical experience and outcome data which
limits accessibility to fertility preservation in this setting. Presently,
oocyte or embryo cryopreservation are the main options for fertility
preservation. IVF success rates are comparable to the ones of non-oncological
populations according to the woman's age but current published studies lack data
on definitive success rates following embryo banking for cancer patients. The
perception that IVF and pregnancy may worsen cancer prognosis remains, despite
the lack of scientific evidence to support this notion. Published studies show
reassuring results for pregnancies occurring >2 years after breast cancer
diagnosis. The best published evidence suggests pregnancy after breast cancer
does not increase the risk of disease recurrence, thus pregnancy should not be
forbidden once treatment is completed. Decision making for women diagnosed with
cancer requires up-to-date knowledge of the efficacy and safety of available
options. Providing consultation with a reproductive specialist and appropriate
information on fertility preservation for these women should be an essential
aspect of their supportive care.
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Affiliation(s)
- Márcia M Carneiro
- Centro de Reprodução Humana Hospital MATER DEI, Belo Horizonte-MG.,Departamento de Ginecologia e Obstetrícia e Obstetrícia da Faculdade de Medicina da UFMG.,Equipe Multidisciplinar de Endometriose Biocor Hospital, Belo Horizonte-MG
| | - Ana M Cota
- Centro de Reprodução Humana Hospital MATER DEI, Belo Horizonte-MG
| | - Maria C Amaral
- Centro de Reprodução Humana Hospital MATER DEI, Belo Horizonte-MG
| | - Moisa L Pedrosa
- Centro de Reprodução Humana Hospital MATER DEI, Belo Horizonte-MG
| | - Bruna O Martins
- Centro de Reprodução Humana Hospital MATER DEI, Belo Horizonte-MG
| | | | - Rivia M Lamaita
- Centro de Reprodução Humana Hospital MATER DEI, Belo Horizonte-MG.,Departamento de Ginecologia e Obstetrícia e Obstetrícia da Faculdade de Medicina da UFMG
| | - Marcia C F Ferreira
- Centro de Reprodução Humana Hospital MATER DEI, Belo Horizonte-MG.,Departamento de Ginecologia e Obstetrícia e Obstetrícia da Faculdade de Medicina da UFMG
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7
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Lopresti M, Rizack T, Dizon DS. Sexuality, fertility and pregnancy following breast cancer treatment. Gland Surg 2018; 7:404-410. [PMID: 30175056 DOI: 10.21037/gs.2018.01.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
For women facing a new diagnosis of breast cancer, treatments can result in changes to intimate issues, including sexual health. For women of reproductive age, other significant concerns include the potential impact on fertility and the safety of pregnancy after treatment. These issues are important to acknowledge and to address, as they can impact on quality of life, not only for the patient, but may impact relationships, both present and future. In this paper we review sexual health after cancer, the importance of proactively addressing fertility, and important issues related to pregnancy following breast cancer.
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Affiliation(s)
- Mary Lopresti
- Lifespan Cancer Institute, Providence, RI, USA.,The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Tina Rizack
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Don S Dizon
- Lifespan Cancer Institute, Providence, RI, USA.,The Warren Alpert Medical School of Brown University, Providence, RI, USA
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8
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Rodgers RJ, Reid GD, Koch J, Deans R, Ledger WL, Friedlander M, Gilchrist RB, Walters KA, Abbott JA. The safety and efficacy of controlled ovarian hyperstimulation for fertility preservation in women with early breast cancer: a systematic review. Hum Reprod 2017; 32:1033-1045. [DOI: 10.1093/humrep/dex027] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/29/2017] [Indexed: 12/29/2022] Open
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Abstract
As the average age that women have their first child increases and cancer therapies improve survival, obstetricians are more likely to care for pregnant women who have survived cancer. Managing these pregnancies can be challenging, as they may be associated with higher risks of maternal and neonatal morbidity and mortality. Different types of cancer require different types of intervention, including surgery, chemotherapy, radiation, or combinations of these. Prior cancer treatments therefore present different potential complications during pregnancy. Although for most women who survive cancer carrying a pregnancy does not seem to increase mortality rates, there are some associated neonatal morbidities. The most common perinatal complication associated with pregnancy after cancer is prematurity. Women who desire pregnancy after cancer survival should not be discouraged, but appropriate counseling and follow-up should be provided.
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10
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McCray DKS, Simpson AB, Flyckt R, Liu Y, O’Rourke C, Crowe JP, Grobmyer SR, Moore HC, Valente SA. Fertility in Women of Reproductive Age After Breast Cancer Treatment: Practice Patterns and Outcomes. Ann Surg Oncol 2016; 23:3175-81. [DOI: 10.1245/s10434-016-5308-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Indexed: 01/09/2023]
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11
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Luke B, Brown MB, Spector LG, Stern JE, Smith YR, Williams M, Koch L, Schymura MJ. Embryo banking among women diagnosed with cancer: a pilot population-based study in New York, Texas, and Illinois. J Assist Reprod Genet 2016; 33:667-674. [PMID: 26843393 DOI: 10.1007/s10815-016-0669-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/24/2016] [Indexed: 12/01/2022] Open
Abstract
PURPOSE The purpose of the present study is to estimate the proportion of women with cancer who return to use the embryos that they have banked and to compare this proportion to that of women without cancer who bank embryos. METHODS This is a cohort study of three groups of women from New York, Texas, and Illinois who used embryo banking in their first assisted reproductive technology (ART) treatment cycle: two groups with cancer (222 women without an infertility diagnosis and 48 women with an infertility diagnosis) and a control group without cancer (68 women with the infertility diagnosis of male factor only). Women were included only if their first ART cycle reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) occurred between 2004 and 2009. Cancer cases were identified from each State Cancer Registry from 5 years prior to initiation of ART treatment to 6 months post-initiation; mean follow-up after the first ART cycle was 2.0 years. RESULTS Women with cancer without an infertility diagnosis returned for a subsequent ART cycle at a lower rate (10.8 %) than those with an infertility diagnosis (31.3 %, p = 0.0010) or the control group (85.3 %, p < 0.0001). Among those who returned for a subsequent cycle, women with cancer waited a longer time to return (14.3 months without an infertility diagnosis and 8.3 months with an infertility diagnosis, p = 0.13) compared to the control group (2.8 months, p = 0.0007). The live birth rate among women who did not utilize embryo banking in their second cycle did not differ significantly across the three study groups, ranging from 25.0 and 42.9 % for women with cancer with and without an infertility diagnosis, respectively, to 36.2 % for women in the control group. CONCLUSIONS Women with cancer without an infertility diagnosis are either less likely to return for subsequent treatment or will wait a longer time to return than women with an infertility diagnosis or those that do not have cancer. A longer-term study is necessary to assess whether these women return to use their frozen embryos after cancer treatment or are able to spontaneously conceive and if those subsequent pregnancies are adversely affected by the cancer diagnosis or therapy.
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Affiliation(s)
- Barbara Luke
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, 965 Fee Road, East Fee Hall, Room 628, East Lansing, Michigan, 48824, USA.
| | - Morton B Brown
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Logan G Spector
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Judy E Stern
- Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Yolanda R Smith
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Melanie Williams
- Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Lori Koch
- Illinois State Cancer Registry, Illinois Department of Public Health, Springfield, Illinois, USA
| | - Maria J Schymura
- New York State Cancer Registry, Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, USA
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12
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Raphael J, Trudeau ME, Chan K. Outcome of patients with pregnancy during or after breast cancer: a review of the recent literature. ACTA ACUST UNITED AC 2015; 22:S8-S18. [PMID: 25848342 DOI: 10.3747/co.22.2338] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND An increasing number of young women are delaying childbearing; hence, more are diagnosed with breast cancer (bca) before having a family. No clear recommendations are currently available for counselling such a population on the safety of carrying a pregnancy during bca or becoming pregnant after treatment for bca. METHODS Using a Web-based search of PubMed we reviewed the recent literature about bca and pregnancy. Our objective was to report outcomes for patients diagnosed with bca during pregnancy, comparing them with outcomes for non-pregnant women, and to evaluate prognosis in women diagnosed with and treated for bca who subsequently became pregnant. RESULTS "Pregnancy and bca" should be divided into two entities. Pregnancy-associated bca tends to be more aggressive and advanced in stage at diagnosis than bca in control groups; hence, it has a poorer prognosis. With respect to pregnancy after bca, there is, despite the bias in reported studies and meta-analyses, no clear evidence for a different or worse disease outcome in bca patients who become pregnant after treatment compared with those who do not. CONCLUSIONS Pregnancy-associated bca should be treated as aggressively as and according to the standards applicable in nonpregnant women; pregnancy after bca does not jeopardize outcome. The guidelines addressing risks connected to pregnancy and bca lack a high level of evidence for better counselling young women about pregnancy considerations and preventing unnecessary abortions. Ideally, evidence from large prospective randomized trials would set better guidelines, and yet the complexity of such studies limits their feasibility.
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Affiliation(s)
- J Raphael
- Medical Oncology Department, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - M E Trudeau
- Medical Oncology Department, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - K Chan
- Medical Oncology Department, Sunnybrook Odette Cancer Centre, Toronto, ON
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13
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Abstract
Breast cancer is one of the most common malignancies of women in the reproductive years. In the Western world there is a trend towards delaying pregnancy to later in life, and in combination with an increased incidence of breast cancer an increased number of women are diagnosed with breast cancer before they have completed their reproductive plans. In addition, breast cancer during pregnancy may affect an increased number of women as the childbearing years are delayed. The survival rate after breast cancer has improved during the last decades, and many young breast cancer survivors will consider a pregnancy subsequent to the completion of adjuvant breast cancer therapy. Traditionally, many women are advised against a pregnancy due to a fear of increased risk of recurrence, especially women with estrogen receptor-positive breast cancer. Due to feasibility issues, evidence from large prospective randomized trials is missing regarding the safety of pregnancy after breast cancer. Today guidelines are based on cohort studies and population-based registry evidence with its limitations. Overall, data suggest that pregnancy after breast cancer therapy is safe, and the current evidence is summarized in this overview.
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Affiliation(s)
- Charlotta Dabrosin
- a Department of Oncology and Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
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