Most young women can conceive, give birth after breast cancer treatment
Click Here to Manage Email Alerts
CHICAGO — The majority of young breast cancer survivors who attempted pregnancy became pregnant, according to prospective study results scheduled for presentation at ASCO Annual Meeting.
Most of the women who became pregnant reported a live birth, findings presented at a pre-ASCO press briefing showed.
“Our study is the first prospective study to follow women diagnosed with any subtype of breast cancer for a median of 11 years and to explore fertility outcomes specifically among the women who are attempting a pregnancy,” researcher Kimia Sorouri, MD, MPH, postdoctoral research fellow at Dana-Farber Cancer Institute, told Healio.
“Many of the past studies reporting on fertility outcomes in this population [did] not ask women if they are attempting to conceive, so the reported numbers of pregnancies and live births do not actually reflect the women who were trying to get pregnant,” Sorouri added. “This is one of the critical strengths of our study.”
Background and methods
A high percentage of young women diagnosed with breast cancer are interested in future fertility.
Previous studies into pregnancy and live birth rates among breast cancer survivors have been limited by lack of prospective assessment of pregnancy attempts, short follow-up and inclusion of select subgroups, according to study background.
Sorouri and colleagues assessed fertility outcomes among 1,213 women with stage 0 to stage III breast cancer who participated in the prospective, multicenter Young Women’s Breast Cancer Study.
All women had been diagnosed with breast cancer at age 40 years between 2006 and 2016.
Study protocol excluded women with metastatic disease at diagnosis, as well as those who had undergone hysterectomy or bilateral oophorectomy.
Investigators used serial surveys to obtain data about pregnancy attempts and fertility outcomes.
Results
The analysis included 197 women (median age at diagnosis, 32 years; range, 17-40; 74% non-Hispanic white) who attempted pregnancy after breast cancer diagnosis.
Most had stage I (41%) or stage II (35%) disease.
The majority had hormone receptor-positive disease (76%), had received chemotherapy (68%) and had received endocrine therapy within a year of diagnosis (57%). Thirteen percent had BRCA1 or BRCA2 germline mutations.
About half (51%) reported financial comfort at baseline, defined as having enough money after paying their bills to buy special things.
Slightly more than one-quarter (28%) had undergone fertility preservation with egg/embryo freezing at diagnosis, and 15% reported a history of infertility prior to breast cancer diagnosis.
Median follow-up was 11 years (range, 3-17).
A majority of women who attempted pregnancy after diagnosis reported at least one pregnancy (73%) and at least one live birth (65%). Median time from diagnosis to first pregnancy was 48 months (range, 6-125).
Multivariable analysis revealed a negative association between older age at diagnosis and pregnancy (OR for each year increase = 0.82; 95% CI, 0.74-0.9). Financial comfort at baseline appeared predictive of pregnancy (OR = 2.04; 95% CI, 1.01-4.12).
Researchers also observed a negative association between older age at diagnosis and live births (OR for each year increase = 0.82; 95% CI, 0.76-0.9). Fertility preservation at diagnosis appeared predictive of live births (OR = 2.78; 95% CI, 1.29-6).
Investigators observed no associations between pregnancy or live birth with infertility history, type of cancer treatment, race, ethnicity, BRCA1/BRCA2 status or nulliparity at diagnosis.
“We found that nearly two-thirds of women were able to have a baby after their breast cancer treatment,” Sorouri said. “Importantly, the women who had undergone fertility preservation — specifically the freezing of eggs or embryos before their cancer treatment — had the highest odds of going on to have a live birth. This finding is key as it highlights the need for fertility preservation services and access to these services in a timely manner before the onset of cancer treatment in order to ensure that these women are able to have the future reproductive potential that they aspire to.”
Perspective
Back to Top
Julie R. Gralow, MD, FACP, FASCO
It is impressive that this is the first study with long-term follow-up to look at fertility and pregnancy in all subtypes of breast cancer. The prior POSITIVE trial included only patients with hormone receptor-positive disease.
It’s also impressive that 68% of patients in this study received chemotherapy, which is known to reduce future fertility.
The conclusion is that pregnancy after a diagnosis of breast cancer is indeed possible for the majority who desire it, and that pregnancy is safe.
Factors that increased the likelihood of being able to achieve pregnancy included younger age at diagnosis, financial comfort and having undergone fertility preservation prior to beginning treatment. We can’t do a lot to impact the first two factors, but we can impact the fertility preservation prior to treatment. It’s critical that every patient be informed of the impact breast cancer diagnosis and treatment can have on future fertility, that we offer fertility preservation to all young patients interested in future fertility prior to beginning treatment, and that we have equitable access for all patients.
Collapse
Sorouri K, et al. Abstract 1518. Presented at: ASCO Annual Meeting; May 31-June 4, 2024.
Click Here to Manage Email Alerts