Study: Is it safe for BRCA mutation carriers to become pregnant following breast cancer?
|At a glance||Questions for your doctor|
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.
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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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.
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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
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.
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.
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 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.
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.
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.
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
- 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.
- 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?
The following research studies related to fertility preservation are enrolling patients.
Fertility preservation studies for women
- NCT01503190: The Immune System's Response to Young Women's Breast Cancer. This an observational trial looking at tissue samples from patients with Pregnancy-Associated Breast Cancer (PABC) versus non-PABC to understand how the immune system responds.
- NCT05443737: Evaluation of a Telehealth Oncofertility Care Intervention in Adolescent and Young Adult Cancer Patients. The purpose of this study is to evaluate the effectiveness of an intervention to improve young cancer survivors' oncofertility care.
- NCT0301168: Fertility Preservation Using Tamoxifen and Letrozole in Sensitive Tumors Trial (TALES). Infertility as a result of cancer treatment effects long-term quality of life in survivors of reproductive-age cancers. This trial will study different options for fertility preservation in patients with estrogen-receptor-positive breast cancer.
- NCT00823654: Serum Biomarkers to Characterize the Effects of Therapy on Ovarian Reserve in Premenopausal Women With Breast Cancer or Mutations. This study will look at how cancer treatment affects the ovaries. Researchers will review blood samples before, during and after cancer treatment to look at levels of hormones that are produced by the ovaries and ask patients to fill out questionnaires about their menstrual cycles (periods), overall health and pregnancies.
- NCT01788839: Longitudinal Sexual and Reproductive Health Study of Women With Breast Cancer and . This study looks at how cancer treatment affects sexual and reproductive function. The patient will be asked to give a blood sample to see if and how cancer treatment affects the ovaries and the ability to have children (fertility). These blood draws are optional; patients can participate in the study questionnaire even if they choose not to have their blood drawn.
- NCT01558544: Cryopreservation of Ovarian Tissue. The study hopes to contribute to the development of technologies of ovarian tissue freezing-thawing the preserve fertility. The study is open to women who will undergo treatment or surgery for cancer or women with an who are considering undergoing risk-reducing surgery.
- NCT01788839: This study's goal is to see how cancer treatment affects sexual and reproductive function. Participants will also be asked to participate in optional blood tests to see if and how cancer treatment affects the ovaries and the ability to have children.
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.
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
- Register for the FORCE Message Boards and post on the Find a Specialist board to connect with other people who share your situation.
- The National Cancer Institute (NCI)-designated comprehensive cancer centers have specialists to manage the fertility effects from cancer prevention or treatment.