Pregnancy after breast cancer is safe, says landmark study

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January 5, 2023 – Planning a child is a life changing decision. For women who have survived breast cancer, the consideration is even more complex.

For a long time there was no definitive research on how pregnancy affected the likelihood of her cancer coming back. But early results of a new study show that women who stopped protective cancer therapies to become pregnant were not at increased risk of their cancer coming back. Almost 3 out of 4 women in the study became pregnant and 64% had a live birth.

One of these “breast cancer babies” was Ronin Andrade, who turns 1 on January 6th. His mom, Shayla Johnson, from Assonet, MA, is planning to bake him an Instagram-worthy cake. She participated in the research study.

“As a woman, I felt like I’d lost my breasts, I’d lost my hair, I’d lost my figure, and the loss of the ability to have a child was overwhelming. But it wasn’t, and 9 pounds, 11 ounces later I have one,” said Johnson, 40, who was diagnosed at age 34 and also carries a dangerous genetic mutation linked to breast cancer known as BRCA2.

One of the most protective treatments to prevent breast cancer from recurring is called “endocrine therapy,” which involves taking certain medications to prevent the recurrence of cancer cells that feed on hormones such as estrogen or progesterone. The recommended duration of endocrine therapy is 5 to 10 years.

The study Johnson participated in, called the POSITIVE study, followed 518 women aged 42 or younger who took a break from endocrine therapy for about 2 years while trying to conceive. The study enrolled women with so-called early-stage (up to stage III) breast cancer that had not spread beyond the breast or nearby lymph nodes. The women completed at least 18 months of endocrine therapy before pausing to try to conceive.

Among study participants, the breast cancer recurrence rate was 8.9% with a median follow-up of approximately 3.5 years. This rate was similar to the mean recurrence rate of 9% within 3 years found by previous studies. The new results from the POSITIVE study were presented at the San Antonio Breast Cancer Symposium in December.

“These data from the POSITIVE study apply to women with hormone-sensitive early breast cancer who desire pregnancy and wish to discontinue endocrine therapy to have a pregnancy,” says lead investigator Ann Partridge, MD, MPH, Associate Chair of Medicine Oncology at the Dana-Farber Cancer Institute. “It does not appear that pregnancy … or discontinuation of endocrine therapy confer a worse prognosis.”

Is pregnancy less likely after breast cancer?

Most cases of breast cancer occur in middle-aged or older women, but 5% of women aged 40 and younger are diagnosed with the disease annually. The new research is important because young women are increasingly delaying childbirth into their 30s. The risk of breast cancer increases with age, so more women are confronted with the disease before having children or completing their families.

“The other important thing to keep in mind is that getting pregnant gets harder as you get older,” says Partridge.

Thus, a woman may be diagnosed in her early 30s, receive active treatment such as a mastectomy, chemotherapy, and radiation for a year, and then be advised on 5 to 10 years of endocrine therapy, which essentially occupies most of her remaining years of fertility.

In addition to examining the safety of interrupting endocrine therapy, the results of the POSITIVE study provided an important new area of ​​analysis that many breast cancer survivors were concerned about: the likelihood of becoming pregnant.

Previous research shows chemotherapy can negatively impact fertility, while endocrine therapy is considered safe — although women shouldn’t take it if they’re trying to conceive, says the oncologist and Dr. medical Matteo Lambertini from the University of Genoa, Italy an expert on pregnancy after breast cancer.

“Half of newly diagnosed women say they are concerned about fertility,” says Lambertini.

The researchers said that the POSITIVE study participants became pregnant or gave birth at a rate equal to or greater than the general population.

Of the 74% of participants who became pregnant, 86% had a live birth. Some women have been off endocrine therapy for longer than the recommended 2 years, according to the data presented at the symposium. Among the participants, 75% had no preterm births, 94% had stage I or II breast cancer, and 62% received chemotherapy.

Partridge says that 43% of the women in the study used some form of assisted reproductive technology (ART), such as B. In vitro fertilization (IVF), but researchers have not yet analyzed what proportion of pregnancies were the result of ART.

“Sometimes people don’t use ART because they are infertile, but because they want to avoid a BRCA mutation or use embryos to get pregnant faster,” says Partridge. “Especially for a BRCA mutation carrier, they might want to implant an embryo that doesn’t have the mutation… We need to dig a lot deeper into this data. There are many nuances.”

Partridge and Lambertini note that longer-term follow-up among study participants is needed to fully understand any longer-term risks of pregnancy or endocrine disruption.

fertility in the foreground

Caitlin Baltera, 34, of Colorado Springs, CO, is 1 year into her 2 year off endocrine therapy while trying to conceive.

“It’s definitely hard to say you’ve got two years left,” says Baltera, who was diagnosed with stage I breast cancer at the age of 30. “Of course, when you’re trying to conceive, everyone tells you, ‘Shut up. Don’t worry.’ And I think I only have 2 years.”

“Most people don’t typically have a breaking point where if you keep trying, you’re putting yourself in danger,” she says.

Baltera, who started a new relationship when she was diagnosed and is now married, has spent nearly $30,000 on fertility treatments, part of it on prepaid IVF cycles. She says her insurance did an excellent job of paying for her cancer treatments, which included chemotherapy, which is known to affect fertility.

Some breast cancer survivors are beginning to call for changes in fertility coverage, similar to an earlier movement that addressed breast reconstruction coverage. US law now requires most group insurance plans to cover the cost of reconstructive breast surgery.

“It has often infuriated me to think that if you want reconstruction or whatever your option is, whether it’s fat grafting or implants, that’s all covered. But fertility is different,” says Baltera. “Many of us are medically infertile. And if you can be proud to offer a reconstruction, there’s this other side benefit that doesn’t seem to be mentioned.”

Caragh Logan from London agrees that there needs to be more focus on the impact of breast cancer on fertility. She was among the many women in a Babies After Breast Cancer Facebook group anxiously awaiting the POSITIVE study results.

“So many young women get breast cancer every year that they have to make really tough decisions and we need direction, we need some clarity,” says 37-year-old Logan. “If it were men and the risk was men, I think they would have looked at things like this earlier.”

Logan was diagnosed with breast cancer in 2017 and had a recurrence in 2020 that spread to her spine. But after treatment, she had so-called no signs of illness. She asked her oncologist if the POSITIVE study results would apply to her situation since her cancer had exceeded study parameters but then responded to treatment.

“My former oncologist said he would be happy if I tried it when I reached my 5 years on tamoxifen [a hormone therapy for breast cancer] in October 2023 if I was willing to take the risk,” says Logan. “But he recently retired and the new oncologist is a lot more cautious.”

She had her eggs removed prior to her first treatment and will consider surrogacy if she stops trying to conceive. But that’s something she says she’ll evaluate when her 5-year endocrine therapy is complete.

According to Lambertini, breast cancer experts plan to officially start discussing the issue of pregnancy in women with breast cancer more advanced than that examined in the POSITIVE study next year. Because treatments have become so successful, women are living longer than ever with a stage IV (or metastatic stage) breast cancer diagnosis. One of Lambertini’s stage IV patients has had a complete response to treatment for 6 years and is desiring a child.

“Right now we can’t say it’s even safe because we don’t have any data,” he says. “We may be able to cure patients with advanced disease. She’s 39, so she’s still on schedule to conceive. But it’s a data-free zone. It is also very difficult for us to advise our patients on this.”

Also in preparation are the results of a large international study looking at the safety of pregnancy in women who carry the BRCA gene mutation, which is associated with an increased risk of cancer. Those results will be published in fall 2023, Lambertini says.

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Pregnancy after breast cancer is safe, says landmark study
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