28 December 2020

There are unique challenges faced by young women with breast cancer. One is that they may not have had the opportunity to have children at the time of their diagnosis. Unfortunately, while there have been studies supporting the safety of fertility workup and egg / embryo harvesting prior to breast cancer treatment and pregnancy after treatment, these treatments are underutilized.

At the recent San Antonio Breast Cancer Symposium, a large meta-analysis of breast cancer outcomes after pregnancy was presented by Dr. Matteo Lambertini. The researchers reviewed 39 studies evaluating pregnancy after breast cancer. They found that patients with a history of breast cancer were less likely to become pregnant compared with the general population but their evaluation did not specifically evaluate women trying to conceive – it is possible that some did not try. Compared with women in the general population, those who had been treated for breast cancer were more likely to deliver prior to full term and to have lower birth weight babies.

Importantly, Dr. Matteo and colleagues found that there was no significantly increased risk of birth defects, and patients who became pregnant after breast cancer actually had lower risks of death and disease recurrence compared with those who did not become pregnant. In addition, they noted that pregnancy appeared safe regardless of BRCA mutation status, lymph node status, receipt of chemotherapy, and amount of time between breast cancer treatment and pregnancy.

An unrelated Swedish study also recently found that women who underwent fertility preservation had a higher live birth rate, and had better overall survival after breast cancer compared with women who had not undergone fertility preservation.

I very clearly remember early in my practice having a discussion with a 44-year old single woman who was childless. Her comment “I never thought I might want to have children until you told me it might not be possible” has stuck with me – we cannot make assumptions about our patients desires or preferences. The findings of these studies should serve as a reminder for physicians that fertility issues should be discussed with ALL women of child-bearing age before treatment is initiated. Patients should feel empowered to initiate the discussions if their oncologist does not.