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Study: Is it safe for BRCA mutation carriers to become pregnant following breast cancer?

Summary

New research shows that pregnancy after breast cancer is safe for women with BRCA mutations and their babies. (9/4/19)

Is it safe for BRCA mutation carriers to become pregnant following breast cancer?

Relevance

This article is most relevant for Women with a BRCA mutation who are considering pregnancy after breast cancer

Relevance Rating Details

Relevance: High

Strength of Science: High

Research Timeline: Post Approval

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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:

Safety and pregnancy outcomes for women with a mutations who become pregnant after breast cancer.

Why is this study important?

There is very little data on the safety of pregnancy and reproductive outcomes (the health of baby and mother) following a breast cancer diagnosis in young BRCA-mutation carriers. This large study addressed this important, unmet medical need.

Study findings: 

This study included patients with , invasive breast cancer (stages I, II, or III). All participants were 40 years old or younger and carried a  mutation. Most (95%) were treated with chemotherapy.

The researchers looked at the mother’s health (pregnancy rate, disease-free status and overall survival) as well as the baby’s health. They found that:

  • Pregnancy following breast cancer is safe for mutation carriers.
  • mutation carriers who became pregnant had similar health outcomes compared to mutation carriers who did not become pregnant.
  • The health of babies born to women with a mutation was not different compared to babies born in the general population.

150 (76.9%) patients conceived. For the 112 patients with pregnancy outcome data

  • Pregnancy complications developed in 13 (11.6%).  
  • Of these, 2 babies (1.8%) had congenital health problems (health issues that appear at birth); this is similar to the rate of congenital health problems among babies in the general population.

What does this mean for me?

If you are a young breast cancer patient with a mutation and disease, it is important for you to know that pregnancy after treatment is considered safe. Although there are no national guidelines outlining how long to wait, most oncologists recommend waiting a specified period of time after treatment ends before getting pregnant. This study showed that pregnancy after breast cancer in mutation carriers does not appear to negatively affect the baby’s health or the mother’s prognosis. These results should reassure breast cancer survivors with a mutation who are interested in future family planning.

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Posted 9/4/19
 

References

Lambertini M, Ameye L, Hamy AS, et al. “Safety of pregnancy following breast cancer (BC) in patients (pts) carrying a mutation (mBRCA): results of an international cohort study.” Presented at: 2019 American Society of Clinical Oncology (ASCO) Annual Meeting; May 31-June 4, 2019; Chicago, IL. Abstract 11506.

Lambertini M, Di Maioc M, Poggiod F, Paganie O, Curiglian G, Del Mastro L, Paluch-Shimong S, Loiblh S, Partridge AH, Azim HA, Peccatorik FA and Demeestere Iet al. “Knowledge, attitudes and practice of physicians towards fertility and pregnancy-related issues in young BRCA-mutated breast cancer patients.”  Reproductive Biomedicine Online. 2019. ; 38(5):  835-844.
 

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:

Women with a BRCA mutation who are considering pregnancy after breast cancer

This article is also relevant for:

people with triple negative breast cancer

people with ER/PR + cancer

people with a genetic mutation linked to cancer risk

people with breast cancer

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IN-DEPTH REVIEW OF RESEARCH
Study background:

Several misconceptions concerning fertility preservation and pregnancy-related issues in breast cancer patients with mutations persist, even among health care providers who provide breast cancer care. For example, a study of physicians’ knowledge and practices towards fertility and pregnancy-related issues in young breast cancer patients showed that 45% of physicians did not believe pregnancy after breast cancer was safe for patients with a mutation. 

Following a breast cancer diagnosis, mutation carriers have a narrow window for pregnancy—this is often when they are considering risk-reducing salpingo and may also face a decreased ovarian reserve.  Focused research efforts can help in two areas: first, to address these patient issues and second, to improve physicians’ knowledge about post-treatment pregnancy for carriers and improve their awareness of available guidelines.

Researchers of this study wanted to know:

About the safety of pregnancy and reproductive outcomes for patients with a mutation with prior breast cancer history. 

Population(s) looked at in the study:

This study enrolled patients with , invasive breast cancer (stages, I, II or III) between January 2000 and December 2012. All patients were ≤40 years old and had a germline (inherited) mutation.

Of the 1,252 study participants, 811 had a germline mutation, 430 had a mutation in , and 11 had a in both and . Most patients (95%) were treated wtih chemotherapy that consisted of anthracycline- and/or taxane-based regimens.

Study design:

This was a , hospital-based study. Primary endpoints in this study were pregnancy rate and disease-free survival; secondary endpoints included overall survival and pregnancy outcomes.

Study findings:  

Following a breast cancer diagnosis, 195 (16%) patients in this study became pregnant. Of these, 16 (8.2%) had an induced abortion and 20 (10.3%) had a spontaneous abortion. 

Pregnant patients were younger and had more ER-negative tumors.

  • Among the 150 (76.9%) patients who conceived and completed pregnancy, 170 babies were born (7 pregnancies were ongoing at the time of the study and the outcomes of 2 pregnancies were unknown).
  • For the 112 patients with pregnancy outcome data
    • Pregnancy complications were described for 13 (11.6%) patients.
    • Congenital anomalies were reported for 2 (1.8%) children (median follow-up was 8.3 years).
    • Pregnant patients had better disease-free survival compared to matched non-pregnant study participants.
    • No difference was observed in overall survival between pregnant and non-pregnant patients.
    • Pregnant patients with a mutation had better outcomes than patients with a mutation in or both BRCA1/2.

Of note, the rate of pregnancy and fetal complications observed in this study are similar to those observed for the general population.

Limitations:

Limitations of this study include:

  • A limited median follow-up of disease-free and overall survival: just 8.3 years. At this time, long-term outcomes for these patients are unknown.
  • All participating patients were followed at major medical centers where they likely received high-quality maternal and fetal care. Whether these results are applicable to patients who may not have a similar quality of care remains unknown.
  • These results are specific to women who have a or mutation. It is unknown if they are also applicable for women with germline mutations in other high-risk breast cancer genes.

Conclusions:

This is the largest study to look at the safety of pregnancy and reproductive outcomes for breast cancer patients with a mutation. For these patients, pregnancy following breast cancer is safe, particularly for patients with a mutation.  Pregnancy does not appear to worsen fetal outcomes or maternal prognosis.  This study provides reassurance to breast cancer patients who have a mutation and are interested in future family planning.

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
  • the importance of follow-up with a gynecologist or fertility specialist to monitor ovarian function over time
  • the risks of infertility due to cancer and related treatment
  • the effects 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 
  • the emotional impact of discussions about fertility preservation
  • financial resources for fertility preservation
  • the 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 dysfunction should be referred to a sexual health specialist. 

Updated: 02/06/2022

Questions To Ask Your Doctor
Questions To Ask Your Doctor

  • Is it safe for me to become pregnant after treatment for breast cancer?
  • How long after treatment should I wait to become pregnant?
  • Can I interrupt hormonal therapy to become pregnant?
  • How will my breast cancer treatment affect my ability to get become pregnant?
  • How will my breast cancer diagnosis and treatment affect the health of a my baby?
  • How will a pregnancy after breast cancer impact my future health?
  • Before I start treatment, is there anything that I should know about preserving my fertility?

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 involving testicular tissue that 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: 09/29/2023

Find Experts
Find Experts

The following resources can help you locate an expert near you or via telehealth. 

Finding fertility experts

  • 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 .  
  • Livestrong has a listing of 450 sites that offer fertility preservation options for people diagnosed with cancer. Financial assistance may be available to make the cost of fertility preservation affordable for more patients.


Other ways to find experts

Updated: 04/07/2023

Related Resources
Related Resources

The following resources focus on fertility and cancer:

Updated: 02/10/2023

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Article Rating Details

Study Rating Details

Relevance: High

  • The research is directly about the safety of pregnancy and pregnancy outcomes in young women with a germline BRCA mutation following an early-stage (1-3) breast cancer diagnosis.
  • These results are not generalizable for women with a germline mutation in a gene other than BRCA1 or BRCA2.
  • These results are not generalizable for women with no germline mutation. 

Scientific Strength: Medium-High

  • The participants are well-specified and relevant to question asked.

  • The appropriate controls are used.

  • The sample size is appropriate

  • This is the largest retrospective study to date, but the data is limited to BRCA mutation carriers.

  • This builds on prior research. Although prior research has been done on pregnancy after breast cancer, few have focused on safety and outcomes for BRCA mutation carriers.