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Study: Childbearing after breast cancer among young survivors

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Contents

At a glance                  Questions for your doctor
Findings               In-depth                
Clinical trials Limitations
Guidelines Resources


STUDY AT A GLANCE

This study is about:

birth rates and birth outcomes of women diagnosed with breast cancer as adolescents or young adults (15-39 years of age).

Why is this study important?

This is the first study to evaluate birth rates and birth outcomes among women who had breast cancer as adolescents or young adults. Researchers questioned whether birth outcomes differed among different types of breast cancer.

Study findings:

  1. Live birth rates are lower among adolescent or young adult breast cancer survivors
    • ​​Adolescent or young adult (AYA) breast cancer survivors have 57% fewer births after diagnosis than age-matched women in the general population who have no history of breast cancer.
    • The study found that as diagnosis age increases, women are less likely to have children. That is, women diagnosed between 15-29 years of age are more likely to have subsequent children than women diagnosed at 29-35 or women diagnosed at 35-39. This study does not determine whether this decrease in birth rate reflects difficulty in conception, pregnancy or personal choices about family planning.
    • Among AYA breast cancer survivors:
      • women with regional or distal cancer had fewer births than those with local or in situ cancer.
      • women treated with chemotherapy had fewer births than those with surgery only, regardless of whether they also had radiation or not.
      • women with ER-positive breast cancer had fewer births than those with ER-negative breast cancer. Researchers note that this may be due to longer cancer treatments or delays in childbearing after ER therapy.
  2. Adverse birth outcomes are similar among AYA survivors and women in the general population, except for women with ER-negative breast cancer.
    • The proportion of women who had preterm births, low weight births, small-for-gestational-age births and C-sections were similar between AYA survivors and women in the general population. Birth outcomes did not differ significantly by endocrine therapy, chemotherapy treatments or with ER-positive status.
      • AYA survivors with ER-negative breast cancer were more likely to have preterm births or low-weight births than women with no breast cancer history, even after adjusting for maternal age and race.
    • Given that birth outcomes are similar between AYA survivors and age-matched women in the general population, researchers suggest that psychological rather than biological barriers to childbearing may lead to a decrease in birth rate among AYA survivors. Alternatively there may also be other unexamined barriers such as those based on marital or socioeconomic status.

What does this mean for me?

If you had breast cancer as an adolescent or young adult, your chance of giving birth is lower than the general population. This lower birth rate may be due to delays in choosing to have children after breast cancer treatment or biological barriers to childbirth. If you were diagnosed at 15 to 29, these rates are closer to those of the general population.

Your chance of having a C-section or having a child who is born prematurely (<37 weeks of gestation), has a low birth weight or is small for gestational age is similar to women who have not had breast cancer.

If you had an ER-negative breast cancer, your chance of having a baby who is born prematurely (<37 weeks of gestation) and/or has a low birth weight is slightly (1.3 times) higher than if you had an ER-positive breast cancer.

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Posted 5/10/18
 

Reference

Anderson C, Engel SM, Anders CK and Nichols HB. "Live birth outcomes after adolescent and young adult breast cancer." International Journal of Cancer. 2018;142(10):1994-2002. Epub Jan 4, 2018.
 

Disclosure

FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

This article is relevant for:

Young breast cancer survivors who wish to become pregnant

This article is also relevant for:

Triple negative breast cancer

ER/PR +

Her2+ breast cancer

Breast cancer survivors

Women under 45

Women over 45

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IN-DEPTH REVIEW OF RESEARCH

Study background:

Breast cancer is the most common cancer among adolescent and young adult (AYA) women ages 15-39. AYA women who have undergone cancer therapy may not have completed childbearing.

Researchers of this study wanted to know:

  1. whether the frequency of live births among AYA breast cancer survivors differs from the general population.
  2. how the frequency of adverse birth outcomes among children born to AYA breast cancer survivors compares to the general population.
  3. whether birth rate and adverse outcomes vary by tumor or cancer treatment.

Populations looked at in this study:

This study, conducted by researchers from the University of North Carolina, evaluated 4,978 women with a first primary breast cancer diagnosis between the ages of 15-39 from January 1, 2000 to December 31, 2013 as listed in the North Carolina Central Cancer Registry.

Researchers evaluated basic demographic information, diagnosis date, , cancer treatment and tumor information. Matched birth certificate information was used to determine race, number of births and total length of pregnancy. Births to women who were pregnant at the time of diagnosis (N=91) were excluded, but subsequent births to these women who also conceived after diagnosis were included (N=6).

For each AYA survivor, researchers randomly sampled 20 women from the general population who had a live birth but did not have a history of breast cancer. The women from the general population were matched by year of delivery and maternal age of each AYA breast cancer survivor (N=6,760 total women without prior breast cancer). The life history of AYA survivors was followed until the women reached age 46, had a live birth, died, or December 31, 2014, whichever occurred first.

Study findings:  

Live birth rates

  1. AYA breast cancer survivors have a lower birth rate than age-matched women in the general population.
    • 5% of AYA survivors gave birth within 5 years of diagnosis.
    • 8% of AYA survivors gave birth within 10 years of diagnosis
    • AYA survivors gave birth approximately 57% less frequently than women in the general population in North Carolina in 2013.
    • Birth rate did not differ significantly by race.
  2. Birth rate differed depending on age of diagnosis.
    • AYA survivors diagnosed at 17-29 years of age were more likely to give birth than those who were diagnosed between ages 29-35. AYA survivors diagnosed at 35-39 were the least likely to give birth.
  3. AYA survivors diagnosed with regional or distal cancer were less likely to give birth than those with local or in situ cancer.
  4. AYA survivors treated with chemotherapy were less likely to give birth than those with surgery only, whether or not they also had radiation.
  5. AYA survivors with ER-negative breast cancer were more likely to have a live birth than AYA survivors with ER-positive breast cancer. This may reflect longer cancer treatment or delay after ER therapy among AYA survivors with ER-positive cancer.
    • AYA survivors with ER-negative cancers were 1.3 times more likely to have a live birth within 8 years after diagnosis.
    • 10 years after diagnosis, similar birth rates (10%) were seen among AYA survivors who had ER-positive and ER-negative cancer.

Birth outcomes among live births

Among the 4,978 AYA survivors, 338 had one birth post diagnosis (48 had 2 births and 8 had 3 or more births). To assess birth outcomes, these 338 AYA survivors with newborns were compared to 6,760 age-matched women from the general population who were not previously diagnosed with cancer.

  1. Average maternal age at delivery was 35 years for the AYA survivors.
  2. Proportions for preterm births, low-weight births, small-for-gestational-age births and C-sections were similar between AYA survivors and women in the general population.
    • Prevalence of preterm births and low-weight births was slightly elevated for women with invasive breast cancer compared to those with no breast cancer history.
    • Small-for-gestational-weight births were similar among AYA survivors and women with no cancer history.
  3. AYA survivors with ER-positive breast cancer had birth outcomes similar to women with no breast cancer history.
  4. AYA survivors with ER-negative breast cancer were more likely to have preterm births or low-weight births than women with no breast cancer history, even after adjusting for maternal age and race.
  5. Birth outcomes did not differ significantly by endocrine therapy or chemotherapy treatments.

Limitations:

Researchers caution that the numbers of births evaluated are small, and some associations observed may have occurred by chance. They could not account for the impact of cancer recurrence on live birth frequency or birth outcomes, as their registry did not provide this information. Other features, such as socioeconomic status or health behaviors, may also confound interpretation. While researchers had information on whether AYA survivors had surgery, chemotherapy and/or radiation, they lacked information about the type of chemotherapy used or other treatment details. Researchers also noted that analysis of birth outcomes among women with particular treatments or tumor types was limited by sample size. Larger future studies are needed to confirm these findings.

Conclusions:

Among adolescent and young adult breast cancer survivors, the cumulative birth rate 10 years after diagnosis was 8%. Of the women evaluated (17-39 years of age at diagnosis), birth rates were lowest for women in their 30s, those with regional or distal cancers, and those treated with chemotherapy. Overall, adverse birth outcomes were not elevated for AYA survivors as compared to women without cancer. Women with ER-negative breast cancers did have an increased frequency of preterm and low-weight births. The importance of fertility counseling and potential fertility preserving methods prior to treatment were highlighted.

Share your thoughts on this XRAYS article by taking our brief survey

Posted 5/10/18

Expert Guidelines
Expert Guidelines

The National Comprehensive Cancer Network (NCCN) has guidelines for oncologists treating young adult women with cancer:

  • Discuss fertility implications before and after treatment.
  • Discuss contraception after treatment.
  • Discuss specific methods for fertility preservation such as freezing embryos, eggs, or ovarian tissue.
  • Some research has looked at whether medications to suppress menstruation may protect the ovaries during treatment with chemotherapy. 

Expert Guidelines
Expert Guidelines

The National Comprehensive Cancer Network (NCCN) provides guidelines for fertility in people diagnosed with cancer. 

The NCCN recommends doctors discuss the following with adolescents and adults with cancer before treatment begins:

  • fertility plans and preferences
  • fertility preservation options, including:
    • whether therapy can be delayed long enough for a cycle of egg stimulation
    • cryopreservation
    • medications like GnRH agonist therapy during to preserve ovarian function in premenopausal women with breast cancer
  • importance of follow-up with a gynecologist or fertility specialist to monitor ovarian function over time
  • risks for infertility due to cancer and related treatment
  • affects of treatment on breastfeeding
  • the importance of avoiding pregnancy and options for safe and effective birth control while in treatment
  • safe timing for considering pregnancy after treatment 
  • emotional impact of discussions about fertility preservation
  • financial resources for fertility preservation
  • effects of treatment on sexual function during and after treatment

Doctors should refer patients as indicated for the following services:

  • All patients who are interested in preserving their fertility should be referred to a fertility preservation clinic before starting treatment.
  • Patients who need assistance with complex medical decision-making should be referred to a mental health professional.
  • Patients who are experiencing sexual disfunction should be referred to a sexual health specialist. 

Updated: 02/06/2022

Questions To Ask Your Doctor
Questions To Ask Your Doctor

  • What options for preserving my fertility are available prior to breast cancer treatment?
  • Is fertility or family planning counseling available?
  • What rates of childbirth and adverse birth outcomes are associated with my breast cancer treatment?

Open Clinical Trials
Open Clinical Trials

The following research studies related to fertility preservation are enrolling patients.

Fertility preservation studies for women

Fertility preservation for men

  • NCT02972801: Testicular Tissue Cryopreservation for Fertility Preservation. Testicular tissue cryopreservation is an experimental procedure where testicular tissue is retrieved and frozen. This technique is reserved for young male patients, with the ultimate goal that their tissue may be used in the future to restore fertility when experimental techniques emerge from the research pipeline.

Updated: 03/16/2022

Find Experts
Find Experts

If you are in your reproductive years and have been diagnosed with cancer, or you are considering steps to lower your cancer risk that will interfere with your fertility, you should request referral to a fertility expert. 

  • The Oncofertility Consortium maintains a national database of healthcare providers with expertise in fertility preservation and treatment of people who are diagnosed with cancer or at high risk for cancer due to an inherited mutation.  

Updated: 11/26/2021

Who covered this study?

Health Imaging

Types of breast cancer in mothers affect newborns differently This article rates 2.5 out of 5 stars

International Federation of Gynecology and Obstetrics

Mother's breast cancer type may affect newborn health status This article rates 2.0 out of 5 stars

How we rated the media

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