January 5, 2023 – Planned Parenthood is a life-changing decision. For women who have survived breast cancer, the considerations are more complex.
For a long time, there have been no definitive studies on how pregnancy affects the likelihood that their cancer will come back. But preliminary results from a new study show no increased risk of cancer recurrence in women who pause protective cancer treatment to become pregnant. Nearly three-quarters of the women in the study became pregnant, and 64 percent had live births.
One of these “post-breast cancer babies” is Ronin Andrade, who will be one year old on January 6. His mother, Shayla Johnson, of Assonette, Mass., plans to bake him an Instagram-worthy cake. She participated in a research trial.
“As a woman, I thought I’d lost my breasts, my hair, my figure, my ability to have children would break me down. But that wasn’t the case, and I gained 9 pounds, 11 ounces,” said Johnson, 40. , who was diagnosed with breast cancer at the age of 34 and also carries a mutation in a risk gene associated with breast cancer called BRCA2.
One of the most protective treatments to prevent breast cancer from coming back is called “endocrine therapy,” which involves taking certain medicines to help prevent cancer cells that feed on hormones like estrogen or progesterone from coming back. The recommended duration of endocrine therapy is 5 to 10 years.
The study, called the POSITIVE trial, in which Johnson was involved, followed 518 women aged 42 or younger who had taken a break from endocrine therapy for about 2 years while trying to conceive. The study enrolled women with so-called early-stage breast cancer (up to stage III), which has not spread beyond the breast or nearby lymph nodes. The women completed at least 18 months of endocrine therapy before suspending pregnancy attempts.
During the average follow-up period of about 3.5 years in the study, the breast cancer recurrence rate was 8.9%. This rate is similar to the average recurrence rate of 9% over 3 years established in previous studies.new positive test result Presented at the San Antonio Breast Cancer Symposium in December.
“These data from the POSITIVE trial apply to women with early-stage hormone-sensitive breast cancer who are trying to conceive and who want to interrupt endocrine therapy to become pregnant,” said lead investigator Ann Partridge, MD, MPH, Vice Chair of Medical Oncology at Dana-Farber Cancer Institute. “It appears that pregnancy … or interruption of endocrine therapy does not lead to worse outcomes.”
Is pregnancy less likely after breast cancer?
Most breast cancer cases occur in middle-aged or older women, but 5 percent of women age 40 and younger are diagnosed with the disease each year. The new findings are important because more and more young women are delaying childbearing until their 30s. The risk of breast cancer increases with age, so more and more women are facing the disease before having children or starting a family.
“Another important thing to note is that as people age, it becomes more difficult to conceive,” Partridge said.
So a woman might be diagnosed in her early 30s, spend a year on aggressive treatments like mastectomy, chemotherapy, and radiation, and then be recommended five to 10 years of endocrine therapy, basically occupying her Fertility remains most of the time.
In addition to examining the safety of withholding endocrine therapy, the positive trial results provide an important new area of analysis that worries many breast cancer survivors: the possibility of pregnancy.
Previous research has shown that chemotherapy can negatively affect fertility, and endocrine therapy is considered safe — although women should not take chemotherapy when they are trying to conceive, says Matteo Lambertini, MD, a breast cancer survivor at the University of Genoa in Italy. Postoperative pregnancy specialist.
“Half of newly diagnosed women said they were concerned about their fertility,” Lambertini said.
Participants in positive trials conceived or gave birth at the same or higher rates than the general population, the researchers said.
Of the 74 percent of participants who became pregnant, 86 percent had a live birth.According to data presented at the meeting, some women did take longer than the recommended 2-year moratorium on endocrine therapy forum. Of the participants, 75% were childbearing, 94% had stage I or II breast cancer, and 62% had received chemotherapy.
Partridge said 43 percent of the women in the study used some form of assisted reproductive technology (ART), such as in vitro fertilization (IVF), but the researchers had not yet analyzed the proportion of pregnancies resulting from ART.
“Sometimes people use ART not because they’re infertile, but because they want to avoid BRCA mutations, or they want to use embryos to get pregnant faster,” Partridge said. “Especially for BRCA mutation carriers, who might want to implant an embryo that doesn’t have the mutation…we’ll have to dig deeper into the data. There’s a lot of nuance.”
Partridge and Lambertini caution that longer follow-up of study participants is needed to fully understand any long-term risks that may arise from pregnancy or from suspending endocrine therapy.
Fertility Frontier
Caitlin Baltera, 34, of Colorado Springs, CO, is now 1 year after taking a 2-year break from endocrine therapy while trying to conceive.
Baltera, who was diagnosed with stage I breast cancer at the age of 30, said: “It must be difficult to be told you have 2 years. Of course, when you are trying to conceive, everyone will tell you, ‘Calm down.'” No Worry. ’ I thought, I only have 2 years. “
“Most people don’t usually have a tipping point, and if you keep trying, you’re probably putting yourself at risk,” she said.
Baltera, who was in a new relationship when she was diagnosed and is now married, has spent nearly $30,000 on fertility treatments, some of which was on prepaid IVF cycles. She said her insurance paid well for her cancer treatment, which included chemotherapy known to affect fertility.
Some breast cancer survivors are starting to call for changes to how fertility coverage is done, similar to the previous movement around breast reconstruction coverage. U.S. law now requires most group insurance plans to cover breast reconstruction surgery.
“It pissed me off a lot of times if you want to have reconstruction or whatever your options are, whether it’s fat grafting or implants. But with fertility, it’s a different story,” says Baltera. “Many of us are medically sterile. If you take pride in providing reconstruction, there’s a side effect that doesn’t seem to be mentioned.”
Caragh Logan of London agrees that more attention needs to be paid to the impact of breast cancer on fertility. She is one of many women in the Babies After Breast Cancer Facebook group eagerly awaiting positive test results.
“With so many young women getting breast cancer every year and having to make really tough decisions, we need some guidance, we need some clarity,” said Logan, 37. “If it’s a man, the risk is a man’s.” , I think they would have looked at things like this earlier.”
Logan was diagnosed with breast cancer in 2017, which recurred and spread to the spine in 2020. But after treatment, she has no signs of the so-called disease. She asked her oncologist if the positive test results applied to her situation, as her cancer had progressed beyond test parameters but subsequently responded to treatment.
“My previous oncologist said that when I was on tamoxifen for 5 years he would be happy to let me try [a hormone therapy for breast cancer] October 2023, if I’m willing to accept the risk,” Logan said. “But he recently retired, and the new oncologist is much more cautious. “
She had her eggs collected prior to her first treatment and would consider surrogacy if she did not continue trying to conceive. But that’s what she says she’ll be evaluating when her 5 years of endocrine therapy are complete.
Next year, breast cancer experts plan to formally start discussing pregnancy in women with more advanced breast cancers than those studied in the POSITIVE trial, Lambertini said. Because treatment has become so successful, women diagnosed with stage IV (or metastatic) breast cancer are living longer than ever before. One of Lambertini’s stage IV patients has had a complete response to treatment for 6 years and wants to have a child.
“Right now we can’t say it’s safe because we don’t have any data,” he said. “We have the potential to cure patients with advanced disease. She’s 39 years old. So she’s still perfectly capable of getting pregnant on time. But it’s a no-data area. It’s also difficult for us to counsel our patients on that.”
Also forthcoming are the results of a large international study looking at the safety of pregnancy in women with BRCA gene mutations, which are linked to an increased risk of cancer. Those results will be available in the fall of 2023, Lambertini said.
