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. 

1 March 2013

A study published in JAMA found that there is an increase in the incidence of young women (age 25-39) diagnosed with metastatic breast cancer. Metastatic breast cancer means that the cancer has already spread outside of the breast, most commonly to the lungs, liver, bone, and brain. Metastatic breast cancer is not curable, although newer treatments have improved the survival rates.

This study evaluated the SEER Database from 1973-2009. They found that while the incidence of breast cancer in young women is low, young women are more likely to have metastatic disease when first diagnosed. One criticism of the study is that we did not have the ability to detect metastatic disease in the 1970’s like we do today. So a woman diagnosed in the 1970’s might have been thought to have earlier stage disease, when in reality the cancer was already present in other areas of the body. Today, we are more likely to use a combination of blood tests and imaging scans to get better idea of the cancer stage – metastatic disease is considered Stage IV.

The following interview discussed some of the limitations of the study, as well as recommendations for young women. All women should be aware of their breasts and their bodies. While breast cancer is not common in young women, it certainly does occur. Any changes should be reported to your physician.

The Young Survival Coalition is an excellent resource and support organization for young men and women diagnosed with breast cancer, as well as their caregivers and support team.