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


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

This article is also relevant for:

Checked Breast cancer survivors

Checked ER/PR +

Checked People with a genetic mutation linked to cancer risk

Checked Triple negative breast cancer

Checked Women under 45


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

Contents

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


STUDY AT A GLANCE

This study is about:

Safety and pregnancy outcomes for women with a BRCA 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 early-stage, invasive breast cancer (stages I, II, or III). All participants were 40 years old or younger and carried a BRCA 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 BRCA mutation carriers.
  • BRCA mutation carriers who became pregnant had similar health outcomes compared to BRCA mutation carriers who did not become pregnant.
  • The health of babies born to women with a BRCA 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 BRCA mutation and early-stage 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 BRCA 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 BRCA mutation who are interested in future family planning.

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. 

Questions To Ask Your Health Care Provider

  • 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

The following clinical trials on cancer patient care are recruiting participants:

IN-DEPTH REVIEW OF RESEARCH
Study background:

Several misconceptions concerning fertility preservation and pregnancy-related issues in breast cancer patients with BRCA 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 BRCA mutation. 

Following a breast cancer diagnosis, BRCA mutation carriers have a narrow window for pregnancy—this is often when they are considering risk-reducing salpingo oophorectomy 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 BRCA 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 BRCA mutation with prior breast cancer history. 

Population(s) looked at in the study:

This study enrolled patients with early-stage, 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) BRCA mutation.

Of the 1,252 study participants, 811 had a BRCA1 germline mutation, 430 had a mutation in BRCA2, and 11 had a germline mutation in both BRCA1 and BRCA2. Most patients (95%) were treated wtih chemotherapy that consisted of anthracycline- and/or taxane-based regimens.

Study design:

This was a retrospective, 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 BRCA1 mutation had better outcomes than patients with a mutation in BRCA2 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 BRCA1 or BRCA2 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 BRCA mutation. For these patients, pregnancy following breast cancer is safe, particularly for patients with a BRCA1 mutation.  Pregnancy does not appear to worsen fetal outcomes or maternal prognosis.  This study provides reassurance to breast cancer patients who have a BRCA mutation and are interested in future family planning.

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Posted 9/4/19

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