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Women who are diagnosed with breast cancer as an adolescent or young adult often have not yet begun or finished childbearing. Researchers studied the impact of breast cancer and related treatment on birth rates and birth outcomes in young survivors. Overall, adverse birth outcomes were not increased for young survivors compared to women without cancer. However, women with ER-negative breast cancers had a modestly higher frequency of preterm and low weight births. The authors highlight the need for fertility counseling and potential fertility preserving methods prior to treatment. (5/10/18)
birth rates and birth outcomes of women diagnosed with breast cancer as adolescents or young adults (15-39 years of age).
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.
International Federation of Gynecology and Obstetrics
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.
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, stage, 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.
Live birth rates
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.
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.
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.
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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.
FORCE Information: Fertility preservation and assisted reproductive technology
FORCE Information: Fertility in people diagnosed with cancer
FORCE Video: Pregnancy and fertility for previvors and survivors
FORCE XRAYS category: Pregnancy and Fertility
FORCE XRAYS category: Survivorship
The POSITIVE Study is an ongoing open clinical trial run by the International Breast Cancer Study Group that may be of interest to women with ER-positive breast cancer who are considering pregnancy.