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Bothou Α, Margioula-Siarkou C, Petousis S, Margioula-Siarkou G, Zervoudis S, Sotiriadis A, Amant F, Dinas K. Sentinel lymph node biopsy for breast cancer during pregnancy: A comprehensive update. Eur J Clin Invest 2024; 54:e14134. [PMID: 38095225 DOI: 10.1111/eci.14134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/27/2023] [Accepted: 11/05/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Pregnant patients diagnosed with breast cancer (PrBC) may receive substantially different treatments compared to general population, considering that certain treatment options cannot be applied during pregnancy due to their potential harmful effects to the foetus. Regarding the use of sentinel lymph node biopsy (SLNB) in pregnant patients, potential concerns include foetal harm from radiation exposure, possible teratogenic effects of blue dyes and maternal anaphylaxis to isosulfan. OBJECTIVE The main objective of the present systematic review is to summarize and present current knowledge and up-to-date evidence about the safety and efficacy of SLNB in PABC. METHODS MEDLINE, Google Scholar and UpToDate databases were searched up to 22 January 2023. Articles studying the safety and effectiveness of SLNB in patients for PrBC were eligible for inclusion in the present review. RESULTS In total, 63 articles that met the inclusion criteria were included in this study. Forty-seven articles were strongly in favour of performing SLNB in PABC, 4 articles were partially in favour, 10 articles were strongly against and 2 articles were partially against performing SLNB in PABC. Sub-categorization based on type of study showed that the majority of studies in favour were of higher level of evidence than those against. Furthermore, there were overall 12 studies reporting on outcomes. There were overall 382 women with PrBC that underwent SLNB. Full data were reported for 237 cases. Overall live birth rate was 95.8%, while overall neonatal complication rate was 3.4%. No case of maternal side effects or anaphylactic reaction, maternal death, stillbirth and neonatal death was reported (0%). CONCLUSIONS Sentinel lymph node biopsy seems to be safe and effective technique for breast cancer during pregnancy.
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Affiliation(s)
- Αnastasia Bothou
- Breast Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
- University of West Attica, Athens, Greece
- Breast Department of Alexandra General Hospital, Athens, Greece
| | - Chrysoula Margioula-Siarkou
- Breast Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
- Gynaecologic Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
| | - Stamatios Petousis
- Breast Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
- Gynaecologic Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
| | - Georgia Margioula-Siarkou
- Breast Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
- Gynaecologic Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
| | - Stefanos Zervoudis
- University of West Attica, Athens, Greece
- Breast Department of REA Hospital, Athens, Greece
- Medical School, University of Montpellier-Nimes, Nimes, France
| | - Alexandros Sotiriadis
- Maternal-Fetal Medicine Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
| | - Fréderic Amant
- Division Gynecologic Oncology, UZ Leuven, Leuven, Belgium
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Konstantinos Dinas
- Breast Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
- Gynaecologic Oncology Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
- Maternal-Fetal Medicine Unit, 2nd Department of Obstetrics and Gynecology, Aristotle University School of Thessaloniki, Thessaloniki, Greece
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Hurren S, Yates K, Nagle C, McAuliffe M. Women's experiences of gestational breast cancer and their interactions with the healthcare system: A scoping review. J Adv Nurs 2023; 79:502-518. [PMID: 36446754 PMCID: PMC10100155 DOI: 10.1111/jan.15510] [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: 06/23/2022] [Revised: 10/16/2022] [Accepted: 10/30/2022] [Indexed: 12/05/2022]
Abstract
AIM To report the evidence of women's experiences following a diagnosis of gestational breast cancer (GBC) and their interactions with the healthcare system. DESIGN A systematic scoping review. DATA SOURCES This scoping review systematically searched Medline, CINAHL, Psych INFO, EMBASE and SCOPUS, in addition to six grey literature databases in October 2021. A 2020 PRISMA flow diagram depicting the flow of information. REVIEW METHODS Guided by six steps in Arksey and OMalley's Framework (2005). One researcher completed the literature review, and four independently screened the titles and abstracts related to the eligibility criteria. RESULTS Totalling 25 articles, these studies comprise 2 quantitative, 20 qualitative, 1 mixed-method and 2 other documents, a book and debate. Thematic analysis was guided by Braun and Clarke (2006) to identify an overarching theme of adjustment that underpinned women's narratives and was reinforced by four major and several minor themes. The four major themes were: psychological impact, motherhood, treatment and communication. The relationship between the themes contextualizes the enormous complexity concerning women's experiences with GBC. CONCLUSION Cancer management for GBC is complex and multifaceted. At a time of conflicting emotions for women, Multidisciplinary teams are well placed to provide support, normalize the woman's experience of motherhood, demonstrate an understanding of treatment effects, and communicate in a considerate and empathetic manner with information that is timely and relevant. GBC management involves doctors, nurses, midwives and many other healthcare professionals, which can add to the impost of diagnosis. IMPACT This scoping review contributes to a better understanding of women's experience of GBC. The results may inform improvements in the support and communication for these women with GBC and their families.
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Affiliation(s)
- Sara Hurren
- College of Health Care Sciences, Centre of Nursing and Midwifery Research, James Cook University, Townsville, Queensland, Australia
| | - Karen Yates
- College of Health Care Sciences, Centre of Nursing and Midwifery Research, James Cook University, Townsville, Queensland, Australia
| | - Cate Nagle
- Townsville Institute of Health Research and Innovation, Townsville Hospital and Health Service, College of Health Care Sciences, Centre of Nursing and Midwifery Research, James Cook University, Townsville, Queensland, Australia
| | - Marie McAuliffe
- College of Health Care Sciences, Centre of Nursing and Midwifery Research, James Cook University, Townsville, Queensland, Australia
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Cancer in pregnancy: treatment effects. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1774-1783. [PMID: 36639533 DOI: 10.1007/s00261-022-03787-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE Pregnant patients present a unique challenge to cancer therapy. Due to the potential catastrophic implications related to teratogenic effects or pregnancy loss, oncologic management of this vulnerable patient group must be strategic and personalized. METHODS This article will discuss the unique treatment approach to the pregnant cancer patient. This includes discussion of the role of imaging during staging, treatment, and follow-up with an emphasis on avoiding ionizing radiation when possible. RESULTS AND CONCLUSION Specific considerations and modifications to standard cancer treatments, including surgery and systemic therapies such as chemotherapy, immunotherapy, targeted and hormone therapies are crucial components of providing oncologic care to minimize negative effects to the mother and developing fetus. Radiation and proton therapy are also options that may be employed in specific circumstances. Finally, this article will address the long-term treatment effects of these therapies on future fertility.
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Pregnancy in Breast Cancer Survivors; Is It Safe? INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-128858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Al-Arsan Al-Yaseen M, Haydar SA, Alali M, Saifo M. Gestational breast cancer in a patient with Crohn's disease: two case reports. J Med Case Rep 2021; 15:633. [PMID: 34961553 PMCID: PMC8711207 DOI: 10.1186/s13256-021-03224-3] [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: 07/09/2020] [Accepted: 12/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background Diagnosis of breast cancer during gestation is a rare occurrence. In addition, the diagnosis of breast cancer in a patient with Crohn’s disease is not common. We present a rare case of gestational breast cancer in a patient with Crohn’s disease, with a concurrent breast cancer diagnosis in her sister. Case presentation A 31-year-old Syrian woman with Crohn’s disease was diagnosed with breast cancer at 30 weeks gestation; she received neoadjuvant chemotherapy during gestation. Incidentally, her 37-year-old sister was also diagnosed concomitantly with breast cancer. Both sisters underwent and successfully completed surgery and adjuvant therapy. At a 5-year review, both patients showed no signs of recurrence. The Crohn’s disease symptoms have also improved after chemotherapy, and the baby born after gestational chemotherapy is currently 5 years old with normal psychomotor development and without any congenital malformations. Conclusions This case report highlights the impact of gestation on breast cancer outcomes, the possibility of giving chemotherapy during gestation, and the effect of chemotherapy on the symptoms of Crohn’s disease. Supplementary Information The online version contains supplementary material available at 10.1186/s13256-021-03224-3.
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Affiliation(s)
| | - Salah Aldin Haydar
- Faculty of Medicine, Damascus University, Fayez Mansour Street, P. O. Box: 222, Damascus, Syria
| | - Mousa Alali
- Department of Oncology, Al-Bairouni University Hospital, Damascus University, Harasta M5, Damascus, Syria
| | - Maher Saifo
- Faculty of Medicine, Damascus University, Fayez Mansour Street, P. O. Box: 222, Damascus, Syria. .,Department of Oncology, Al-Bairouni University Hospital, Damascus University, Harasta M5, Damascus, Syria. .,Faculty of Pharmacy, Alsham Private University, Damascus, Syria.
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Martinez-Cannon BA, Barragan-Carrillo R, Villarreal-Garza C. Young Women with Breast Cancer in Resource-Limited Settings: What We Know and What We Need to Do Better. BREAST CANCER (DOVE MEDICAL PRESS) 2021; 13:641-650. [PMID: 34880675 PMCID: PMC8648095 DOI: 10.2147/bctt.s303047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Abstract
Young women with breast cancer (YWBC) account for a variable proportion of patients diagnosed with breast cancer around the globe, with a higher prevalence in resource-limited settings than in high-income countries. This group represents a unique population that warrants special attention due to specific biological considerations and age-specific supportive care issues. This review aims to explore existing knowledge regarding YWBC's needs, particularly in resource-restricted settings. To date, scarce information regarding the care of YWBC in resource-constrained countries is available, with most reports describing suboptimal care in terms of survivorship needs. Health care providers should implement actions to improve endocrine treatment adherence, referrals for fertility counseling and preservation, contraceptive use compliance, timely body image and sexual function interventions, comprehensive genetic risk assessments, and early quality of life and psychosocial health interventions. While high costs act as a barrier for optimal care in resource-limited settings, improving patient education represents a promising and cost-effective solution to improve patient care. Future research on developing tailored educational resources for YWBC in resource-limited settings should be considered a priority.
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Affiliation(s)
- Bertha Alejandra Martinez-Cannon
- Hematology-Oncology Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama en Mexico, Mexico City, Mexico
| | - Regina Barragan-Carrillo
- Hematology-Oncology Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama en Mexico, Mexico City, Mexico
| | - Cynthia Villarreal-Garza
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama en Mexico, Mexico City, Mexico
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
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Safi N, Saunders C, Hayen A, Anazodo A, Lui K, Li Z, Remond M, Nicholl M, Wang AY, Sullivan E. Gestational breast cancer in New South Wales: A population-based linkage study of incidence, management, and outcomes. PLoS One 2021; 16:e0245493. [PMID: 33481842 PMCID: PMC7822528 DOI: 10.1371/journal.pone.0245493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/30/2020] [Indexed: 12/22/2022] Open
Abstract
Background The incidence of gestational breast cancer (GBC) is increasing in high-income countries. Our study aimed to examine the epidemiology, management and outcomes of women with GBC in New South Wales (NSW), Australia. Methods A retrospective cohort study using linked data from three NSW datasets. The study group comprised women giving birth with a first-time diagnosis of GBC while the comparison group comprised women giving birth without any type of cancer. Outcome measures included incidence of GBC, maternal morbidities, obstetric management, neonatal mortality, and preterm birth. Results Between 1994 and 2013, 122 women with GBC gave birth in NSW (crude incidence 6.8/ 100,000, 95%CI: 5.6–8.0). Women aged ≥35 years had higher odds of GBC (adjusted odds ratio (AOR) 6.09, 95%CI 4.02–9.2) than younger women. Women with GBC were more likely to give birth by labour induction or pre-labour CS compared to women with no cancer (AOR 4.8, 95%CI: 2.96–7.79). Among women who gave birth by labour induction or pre-labour CS, the preterm birth rate was higher for women with GBC than for women with no cancer (52% vs 7%; AOR 17.5, 95%CI: 11.3–27.3). However, among women with GBC, preterm birth rate did not differ significantly by timing of diagnosis or cancer stage. Babies born to women with GBC were more likely to be preterm (AOR 12.93, 95%CI 8.97–18.64), low birthweight (AOR 8.88, 95%CI 5.87–13.43) or admitted to higher care (AOR 3.99, 95%CI 2.76–5.76) than babies born to women with no cancer. Conclusion Women aged ≥35 years are at increased risk of GBC. There is a high rate of preterm birth among women with GBC, which is not associated with timing of diagnosis or cancer stage. Most births followed induction of labour or pre-labour CS, with no major short term neonatal morbidity.
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Affiliation(s)
- Nadom Safi
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Christobel Saunders
- Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Antoinette Anazodo
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Kei Lui
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Zhuoyang Li
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Marc Remond
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Michael Nicholl
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Alex Y. Wang
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Elizabeth Sullivan
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- * E-mail:
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Jaques R, Xu S, Matsakas A. Evaluating Trastuzumab in the treatment of HER2 positive breast cancer. Histol Histopathol 2020; 35:1059-1075. [PMID: 32323293 DOI: 10.14670/hh-18-221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The transmembrane oncoprotein HER2 is encoded by ERBB2 gene and overexpressed in around 20% of invasive breast cancers. It can be specifically targeted by Trastuzumab (Herceptin®), a humanised IgG1 antibody. Trastuzumab has been regarded as one of the most effective therapeutic drugs targeted to HER2 positive cancers. However, there are drawbacks, notably cardiotoxicity and resistance, which have raised awareness in clinical use. Therefore, understanding the mechanism of action is vital to establish improved therapeutic strategies. Here we evaluate Trastuzumab application in the treatment of HER2 positive breast cancer, focusing on its mechanistic actions and clinical effectiveness. Alternative therapies targeting the HER2 receptor and its downstream anomalies will also be discussed, as these could highlight further targets that could be key to improving clinical outcomes.
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Affiliation(s)
- Ryan Jaques
- Centre for Atherothrombotic and Metabolic Disease, Hull York Medical School, University of Hull, Hull, UK.
| | - Sam Xu
- Centre for Atherothrombotic and Metabolic Disease, Hull York Medical School, University of Hull, Hull, UK
| | - Antonios Matsakas
- Centre for Atherothrombotic and Metabolic Disease, Hull York Medical School, University of Hull, Hull, UK
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Abstract
IntroductionPregnancy-associated breast cancer is relatively uncommon, with few guidelines for management. Women with an active breast cancer diagnosis who wish to offer their children breast milk (either first or second hand) face a number of obstacles and gaps in information.MethodThis article presents a case study and summary of current research on the topic of breastfeeding and breast cancer.Results and DiscussionDifferent types of cancer and cancer treatment influence whether a woman will be able to breastfeed. Some mothers can resume breastfeeding after treatment. If treatment is lengthy, breastfeeding may need to cease permanently. Mothers may need to take medications to help them wean. Finally some mothers may use donor milk to feed their babies once they are no longer able to breastfeed.ConclusionsFurther research is needed to determine and formalize guidelines related to the safety of breastfeeding with an active cancer diagnosis. And there is a need for increased access to breast milk for mothers who are unable to breastfeed. There are geographic barriers, as well as obstacles related to availability and cost.
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Ramaswamy R, Joshi N, Khan MA, Siddhara S. Nanosomal docetaxel lipid suspension based chemotherapy in a pregnant MBC patient - a case report. Onco Targets Ther 2019; 12:5679-5685. [PMID: 31406465 PMCID: PMC6642620 DOI: 10.2147/ott.s206573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 06/15/2019] [Indexed: 12/12/2022] Open
Abstract
The current report presents a case of a pregnant woman with breast cancer metastasized to liver and lungs. The standard of care for breast cancer in pregnancy is anthracycline/taxane-based chemotherapy regimens. Docetaxel has shown a favorable toxicity profile during the second and third trimesters of pregnancy. A novel nanosomal docetaxel lipid suspension (NDLS) (DoceAqualip), with a proven efficacy and tolerability profile, has been approved in India for the treatment of advanced solid tumors since 2013. We present here a case of a pregnant woman with metastatic breast cancer managed with NDLS based TAC regimen showing a partial response after six cycles. The patient delivered a healthy male child with normal Apgar score and weight at the 32nd week of gestation.
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Affiliation(s)
- Rajkumar Ramaswamy
- Department of Medical Oncology, Velammal Medical College and Research Institute, Madurai, Tamil Nadu 625009, India
| | - Nisarg Joshi
- Department of Medical Affairs & Clinical Development, Intas Pharmaceuticals Ltd., Ahmedabad, Gujarat 380054, India
| | - Mujtaba A Khan
- Department of Medical Affairs & Clinical Development, Intas Pharmaceuticals Ltd., Ahmedabad, Gujarat 380054, India
| | - Seerin Siddhara
- Department of Medical Oncology, Velammal Medical College and Research Institute, Madurai, Tamil Nadu 625009, India
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Buonomo B, Brunello A, Noli S, Miglietta L, Del Mastro L, Lambertini M, Peccatori FA. Tamoxifen Exposure during Pregnancy: A Systematic Review and Three More Cases. Breast Care (Basel) 2019; 15:148-156. [PMID: 32398983 DOI: 10.1159/000501473] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/13/2019] [Indexed: 12/16/2022] Open
Abstract
Tamoxifen is frequently used as adjuvant treatment in premenopausal patients with hormone receptor-positive early breast cancer. According to guidelines, the use of nonhormonal barrier contraception is recommended during tamoxifen treatment and up to 3 months after its interruption prior to attempting conception. Nevertheless, when conception occurs inadvertently during tamoxifen treatment, the effects on the fetus and on the course of pregnancy are still not completely known. Here, we report 3 cases of young women who accidentally became pregnant while taking tamoxifen and perform a systematic review of the literature to provide more elements for better and clear multidisciplinary counselling of women facing this challenging situation.
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Affiliation(s)
- Barbara Buonomo
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.,Fertility and Procreation Unit, Division of Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Antonella Brunello
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - Stefania Noli
- Fertility and Procreation Unit, Division of Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Loredana Miglietta
- U.O.C. Oncologia Medica 2, Department of Medical Oncology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucia Del Mastro
- S.S. Sviluppo Terapie Innovative, Department of Medical Oncology, Ospedale Policlinico San Martino, Genoa, Italy.,Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy.,Clinica di Oncologia Medica, Department of Medical Oncology, Ospedale Policlinico San Martino - IST, Genoa, Italy
| | - Fedro Alessandro Peccatori
- Fertility and Procreation Unit, Division of Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
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