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Pregnancy did not affect maternal prognosis of breast cancer
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Women who were diagnosed with breast cancer during pregnancy experienced similar DFS and OS rates as women who were not pregnant, according to study results.
The findings will help counsel patients, as well as further support decisions pregnant women with breast cancer make to initiate treatment and not terminate pregnancy.
Frederic Amant
“Historically, it was believed that the high hormone levels added to a worse outcome and a termination of pregnancy was thought to improve the outcome,” Frederic Amant, MD, PhD, of University Hospitals Leuven and Katholieke University Leuven in Belgium told HemOnc Today. “Since then, conflicting data have arisen, but this series is the largest and well controlled. We compared two groups with similar characteristics. The only difference was the pregnant state, and the outcome was similar.”
The cohort included 1,176 women with breast cancer, 311 of whom were pregnant. Median ages were 33 years for pregnant women and 41 years for nonpregnant women.
Median follow-up was 5 years and 1 month.
Among pregnant women, 47.03% received adjuvant chemotherapy and 71.13% received neoadjuvant chemotherapy. Chemotherapy was administered to 64.31% of women during the second or third trimester of pregnancy.
Among nonpregnant women, 30.88% received adjuvant chemotherapy and 77.45% received neoadjuvant chemotherapy.
During follow-up, researchers reported 42 deaths among pregnant women and 103 deaths among nonpregnant women.
Overall 5-year DFS was 78%, and median time of DFS was 131 months. Five-year OS was 87%.
The researchers did not observe a worse prognosis for women diagnosed with breast cancer during pregnancy with regard to DFS (HR=1.34; 95% CI, 0.93-1.91) or OS (HR=1.19; 95% CI, 0.73-1.93).
“When standard treatment is closely applied, the chances of the mother are similar to nonpregnant women,” Amant said. “A termination will not improve the maternal prognosis. This is an important message.”
Cox regression analysis indicated 5-year DFS of pregnant women would have increased from 65% to 71% and OS would have increased from 78% to 81% had these women not been pregnant.
“In concert with our recent findings published in Lancet Oncology, our data suggest maternal and fetal safety when breast cancer treatment is applied during pregnancy,” he said. “In order to preserve the maternal prognosis, cancer treatment should adhere to standard treatment as much as possible. Maternal cancer treatment is a means to reach fetal maturity, the most important fetal prognostic factor. Preterm delivery with subsequent postpartal cancer treatment may result in long term problems due to prematurity.”
Frederic Amant, MD, PhD, can be reached at University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; email: frederic.amant@uzleuven.be.
Disclosure: Amant reports no relevant financial disclosures.
Perspective
Back to TopMaura N. Dickler, MD
This study is the largest cohort study to date that examines the survival of patients with primary breast cancer that is diagnosed during pregnancy. Historically there have been concerns for a worse outcome for pregnant breast cancer patients attributed to delay in diagnosis, modified breast cancer treatment due to the pregnancy, and increased circulating endogenous levels of estrogen during pregnancy. Although there were imbalances in this cohort study between the pregnant and control patients, this multivariate analysis adjusted for these factors, including age (pregnant patients were younger), stage (pregnant patients were diagnosed with more advanced-stage disease) and hormone receptor status (triple-negative breast cancer accounted for a larger proportion of breast cancer in the pregnant cohort).
With these caveats in mind, these data are reassuring that survival is similar for patients with primary breast cancer diagnosed during pregnancy compared with non-pregnant patients. It remains important to treat pregnant patients with appropriate surgery and chemotherapy to ensure an equal chance of survival compared with non-pregnant patients.
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