Skip to main content

Advertisement

Log in

Hereditary Breast Cancer, Genetics, and Fertility Preservation

  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Fertility preservation is an important consideration in patients with hereditary breast cancer. Breast cancer mutation carriers may present with their cancers at younger ages and require more gonadotoxic treatments. The intent of this review is to discuss the data and research behind the particular fertility challenges mutation carriers may encounter.

Recent Findings

Limited data exist for the impact of hereditary breast cancer genes on fertility in breast cancer patients. Data is conflicting on baseline fertility of BRCA1/2 carriers, but breast cancer patients with these mutations become pregnant more often than noncarrier patients. Artificial reproductive technologies (ART) appear to be safe in this patient population, and these patients may benefit from preimplantation genetic testing.

Summary

Discussion of future fertility is important at time of diagnosis of a cancer mutation and breast cancer. Additional research is needed on mutation carriers to determine how their pathogenic variants affect fertility and risks of fertility preservation options.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Data Availability

Not Applicable.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Tung N, Battelli C, Allen B, Kaldate R, Bhatnagar S, Bowles K, et al. Frequency of mutations in individuals with breast cancer referred for BRCA1 and BRCA2 testing using next-generation sequencing with a 25-gene panel. Cancer. 2015;121(1):25–33.

    Article  CAS  PubMed  Google Scholar 

  2. Michailidou K, Beesley J, Lindstrom S, Canisius S, Dennis J, Lush M, et al. Genome-wide association analysis of more than 120,000 individuals identifies 15 new susceptibility loci for breast cancer. Nat Genet. 2015;47(4):373–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. •• National Comprehensive Cancer Network (NCCN). NCCN guidelines version 3.2023 genetic/familial high-risk assessment: breast, ovarian, and pancreatic. NCCN clinical practice guidelines in oncology; 2023. The NCCN Guidelines provider the current evidence and recommendations for hereditary breast cancer gene risks and management. The guidelines are updated at least annually by a panel of experts, and newer versions of the guidelines can be used to find the current data and recommendations after the date of this publication.

  4. Cathcart-Rake EJ, Ruddy KJ, Bleyer A, Johnson RH. Breast cancer in adolescent and young adult women under the age of 40 years. JCO Oncol Pract. 2021;17(6):305–13.

    Article  PubMed  Google Scholar 

  5. Daly MB, Rosenthal E, Cummings S, Bernhisel R, Kidd J, Hughes E, et al. The association between age at breast cancer diagnosis and prevalence of pathogenic variants. Breast Cancer Res Treat. 2023;199(3):617–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Anglian Breast Cancer Study Group. Prevalence and penetrance of BRCA1 and BRCA2 mutations in a population-based series of breast cancer cases. Anglian Breast Cancer Study Group. Br. J Cancer. 2000;83(10):1301–8. https://doi.org/10.1054/bjoc.2000.1407.

  7. Stevens KN, Vachon CM, Couch FJ. Genetic susceptibility to triple negative breast cancer. Cancer Res. 2013;73(7):2025–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Fostira F, Tsitlaidou M, Papadimitriou C, Pertesi M, Timotheadou E, Stavropoulou AV, et al. Prevalence of BRCA1 mutations among 403 women with triple-negative breast cancer: implications for genetic screening selection criteria: a Hellenic Cooperative Oncology Group Study. Breast Cancer Res Treat. 2012;134(1):353–62.

    Article  CAS  PubMed  Google Scholar 

  9. Lakhani SR, Van De Vijver MJ, Jacquemier J, Anderson TJ, Osin PP, McGuffog L, et al. The pathology of familial breast cancer: predictive value of immunohistochemical markers estrogen receptor, progesterone receptor, HER-2, and p53 in patients with mutations in BRCA1 and BRCA2. J Clin Oncol. 2002;20(9):2310–8.

    Article  CAS  PubMed  Google Scholar 

  10. Kurian AW, Abrahamse P, Bondarenko I, Hamilton AS, Deapen D, Gomez SL, et al. Association of genetic testing results with mortality among women with breast cancer or ovarian cancer. JNCI: J Natl Cancer Inst. 2022;114(2):245–53.

    Article  PubMed  Google Scholar 

  11. Copson ER, Maishman TC, Tapper WJ, Cutress RI, Greville-Heygate S, Altman DG, et al. Germline BRCA mutation and outcome in young-onset breast cancer (POSH): a prospective cohort study. Lancet Oncol. 2018;19(2):169–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Marabelli M, Cheng SC, Parmigiani G. Penetrance of ATM gene mutations in breast cancer: a meta-analysis of different measures of risk. Genet Epidemiol. 2016;40(5):425–31.

    Article  PubMed  PubMed Central  Google Scholar 

  13. van Os NJH, Roeleveld N, Weemaes CMR, Jongmans MCJ, Janssens GO, Taylor AMR, et al. Health risks for ataxia-telangiectasia mutated heterozygotes: a systematic review, meta-analysis and evidence-based guideline. Clin Genet. 2016;90(2):105–17.

    Article  PubMed  Google Scholar 

  14. Hu C, Hart SN, Gnanaolivu R, Huang H, Lee KY, Na J, et al. A population-based study of genes previously implicated in breast cancer. N Engl J Med. 2021;384(5):440–51.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kuchenbaecker KB, Hopper JL, Barnes DR, Phillips KA, Mooij TM, Roos-Blom MJ, et al. Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA. 2017;317(23):2402–16.

    Article  CAS  PubMed  Google Scholar 

  16. Kaurah P, MacMillan A, Boyd N, Senz J, De Luca A, Chun N, et al. Founder and recurrent CDH1 mutations in families with hereditary diffuse gastric cancer. JAMA. 2007;297(21):2360–72.

    Article  CAS  PubMed  Google Scholar 

  17. Pharoah PD, Guilford P, Caldas C. International Gastric Cancer Linkage Consortium. Incidence of gastric cancer and breast cancer in CDH1 (E-cadherin) mutation carriers from hereditary diffuse gastric cancer families. Gastroenterology. 2001;121(6):1348–53.

    Article  CAS  PubMed  Google Scholar 

  18. Germline pathogenic variants in cancer predisposition genes among women with invasive lobular carcinoma of the breast. J Clin Oncol. https://doi.org/10.1200/JCO.21.00640. Available from: [cited 2023 May 20]

  19. Cybulski C, Wokołorczyk D, Jakubowska A, Huzarski T, Byrski T, Gronwald J, Masojć B, Deebniak T, Górski B, Blecharz P, Narod SA, Lubiński J. Risk of breast cancer in woman with a CHEK2 mutation with and without a family history of breast cancer. J Clin Oncol. 2011;29(28):3747–52. https://doi.org/10.1200/JCO.2010.34.0778.

    Article  CAS  PubMed  Google Scholar 

  20. Seminog OO, Goldacre MJ. Age-specific risk of breast cancer in women with neurofibromatosis type 1. Br J Cancer. 2015;112(9):1546–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Uusitalo E, Rantanen M, Kallionpää RA, Pöyhönen M, Leppävirta J, Ylä-Outinen H, et al. Distinctive cancer associations in patients with neurofibromatosis type 1. J Clin Oncol. 2016;34(17):1978–86.

    Article  PubMed  Google Scholar 

  22. Antoniou AC, Casadei S, Heikkinen T, Barrowdale D, Pylkäs K, Roberts J, et al. Breast-cancer risk in families with mutations in PALB2. N Engl J Med. 2014;371(6):497–506.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Shimelis H, LaDuca H, Hu C, Hart SN, Na J, Thomas A, et al. Triple-negative breast cancer risk genes identified by multigene hereditary cancer panel testing. JNCI: J Natl Cancer Inst. 2018;110(8):855–62.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Pilarski R, Burt R, Kohlman W, Pho L, Shannon KM, Swisher E. Cowden syndrome and the PTEN hamartoma tumor syndrome: systematic review and revised diagnostic criteria. J Natl Cancer Inst. 2013;105(21):1607–16.

    Article  CAS  PubMed  Google Scholar 

  25. Hendricks LAJ, Hoogerbrugge N, Mensenkamp AR, Brunet J, Lleuger-Pujol R, Høberg-Vetti H, et al. Cancer risks by sex and variant type in PTEN hamartoma tumor syndrome. J Natl Cancer Inst. 2023;115(1):93–103.

    Article  PubMed  Google Scholar 

  26. Hearle N, Schumacher V, Menko FH, Olschwang S, Boardman LA, Gille JJP, et al. Frequency and spectrum of cancers in the Peutz-Jeghers syndrome. Clin Cancer Res. 2006May 15;12(10):3209–15.

    Article  CAS  PubMed  Google Scholar 

  27. Mai PL, Best AF, Peters JA, DeCastro R, Khincha PP, Loud JT, et al. Risks of first and subsequent cancers among TP53 mutation-carriers in the NCI LFS cohort. Cancer. 2016;122(23):3673–81.

    Article  CAS  PubMed  Google Scholar 

  28. Hu C, Polley EC, Yadav S, Lilyquist J, Shimelis H, Na J, et al. The contribution of germline predisposition gene mutations to clinical subtypes of invasive breast cancer from a clinical genetic testing cohort. J Natl Cancer Inst. 2020;112(12):1231–41.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Mavaddat N, Dorling L, Carvalho S, Allen J, González-Neira A, Keeman R, et al. Pathology of tumors associated with pathogenic germline variants in 9 breast cancer susceptibility genes. JAMA Oncol. 2022;8(3):e216744.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Breast cancer risk genes — association analysis in more than 113,000 women. N Engl J Med 2021;384(5):428–39

  31. Bychkovsky BL, Agaoglu NB, Horton C, Zhou J, Yussuf A, Hemyari P, Richardson ME, Young C, LaDuca H, McGuinness DL, Scheib R, Garber JE, Rana HQ. Differences in cancer phenotypes among frequent CHEK2 variants and implications for clinal care-checking CHEK2. JAMA Oncol. 2022;8(11):1598–606. https://doi.org/10.1001/jamaoncol.2022.4071.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lambertini M, Peccatori FA, Demeestere I, Amant F, Wyns C, Stukenborg JB, et al. Fertility preservation and post-treatment pregnancies in post-pubertal cancer patients: ESMO Clinical Practice Guidelines†. Ann Oncol. 2020;31(12):1664–78.

    Article  CAS  PubMed  Google Scholar 

  33. Oncul M, Ozcivit IB, Basibuyuk Z, Cebi C, Sahmay S. Anti-Müllerian hormone, an ovarian reserve marker in hypogonadotropic hypogonadism. Eur J Obstet Gynecol Reprod Biol. 2022;273:54–8.

    Article  CAS  PubMed  Google Scholar 

  34. Tutt ANJ, Garber JE, Kaufman B, Viale G, Fumagalli D, Rastogi P, et al. Adjuvant olaparib for patients with bRCA1- or BRCA2-mutated breast cancer. N Engl J Med. 2021;384(25):2394–405.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Li J, Li Q, Zhang L, Zhang S, Dai Y. Poly-ADP-ribose polymerase (PARP) inhibitors and ovarian function. Biomed Pharmacother. 2023;157:114028.

    Article  CAS  PubMed  Google Scholar 

  36. Dezellus A, Barriere P, Campone M, Lemanski C, Vanlemmens L, Mignot L, et al. Prospective evaluation of serum anti-Müllerian hormone dynamics in 250 women of reproductive age treated with chemotherapy for breast cancer. Eur J Cancer. 2017;79:72–80.

    Article  CAS  PubMed  Google Scholar 

  37. Giri N, Reed HD, Stratton P, Savage SA, Alter BP. Pregnancy outcomes in mothers of offspring with inherited bone marrow failure syndromes. Pediatr Blood Cancer. 2018;65(1). https://doi.org/10.1002/pbc.26757

  38. Turan V, Oktay K. BRCA-related ATM-mediated DNA double-strand break repair and ovarian aging. Hum Reprod Update. 2020;26(1):43–57.

    Article  CAS  PubMed  Google Scholar 

  39. Pal T, Keefe D, Sun P, Narod SA. Fertility in women with BRCA mutations: a case-control study. Fertil Steril. 2010;93(6):1805–8.

    Article  CAS  PubMed  Google Scholar 

  40. Finch A, Valentini A, Greenblatt E, Lynch HT, Ghadirian P, Armel S, et al. Frequency of premature menopause in women who carry a BRCA1 or BRCA2 mutation. Fertil Steril. 2013;99(6):1724–8.

    Article  CAS  PubMed  Google Scholar 

  41. • Gunnala V, Fields J, Irani M, D’Angelo D, Xu K, Schattman G, et al. BRCA carriers have similar reproductive potential at baseline to noncarriers: comparisons in cancer and cancer-free cohorts undergoing fertility preservation. Fertil Steril. 2019;111(2):363–71. This study found that BRCA1/2 carriers had similar rates of fertility to noncarriers including both those with and without cancer diagnoses.

    Article  CAS  PubMed  Google Scholar 

  42. Kwiatkowski F, Arbre M, Bidet Y, Laquet C, Uhrhammer N, Bignon YJ. BRCA mutations increase fertility in families at hereditary breast/ovarian cancer risk. PLoS ONE. 2015;10(6):e0127363.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Huber D, Seitz S, Kast K, Emons G, Ortmann O. Use of fertility treatments in BRCA1/2 mutation carriers and risk for ovarian and breast cancer: a systematic review. Arch Gynecol Obstet. 2020;302(3):715–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Kotsopoulos J, Librach CL, Lubinski J, Gronwald J, Kim-Sing C, Ghadirian P, et al. Infertility, treatment of infertility, and the risk of breast cancer among women with BRCA1 and BRCA2 mutations: a case-control study. Cancer Causes Control. 2008;19(10):1111–9.

    Article  PubMed  Google Scholar 

  45. Kim J, Turan V, Oktay K. Long-term safety of letrozole and gonadotropin stimulation for fertility preservation in women with breast cancer. J Clin Endocrinol Metab. 2016;101(4):1364–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. •• Liu X, Yue J, Pervaiz R, Zhang H, Wang L. Association between fertility treatments and breast cancer risk in women with a family history or BRCA mutations: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2022;13:986477. This study found the BRCA1/2 carriers and other women with family histories of breast cancer did not increase their risk of breast cancer with fertility treatment including use of IVF, clomiphene citrate, letrozole, and gonadotropins.

    Article  PubMed  PubMed Central  Google Scholar 

  47. • Lambertini M, Ameye L, Hamy AS, Zingarello A, Poorvu PD, Carrasco E, et al. Pregnancy after breast cancer in patients with germline BRCA mutations. J Clin Oncol. 2020;38(26):3012–23. This study reported that breast cancer patients with BRCA1/2 mutations were twice as likely to become pregnant after their cancer diagnosis, indicating the importance of fertility considerations in this patient population.

    Article  PubMed  Google Scholar 

  48. Zhang J, Walsh MF, Wu G, Edmonson MN, Gruber TA, Easton J, et al. Germline mutations in predisposition genes in pediatric cancer. N Engl J Med. 2015;373(24):2336–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Kufel-Grabowska J, Podolak A, Maliszewski D, Bartoszkiewicz M, Ramlau R, Lukaszuk K. Fertility counseling in BRCA1/2-mutated women with breast cancer and healthy individuals. J Clin Med. 2022;11(14):3996.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Lambertini M, Goldrat O, Toss A, Azim HA, Peccatori FA, Ignatiadis M, et al. Fertility and pregnancy issues in BRCA-mutated breast cancer patients. Cancer Treat Rev. 2017;59:61–70.

    Article  PubMed  Google Scholar 

  51. Turan V, Bedoschi G, Emirdar V, Moy F, Oktay K. Ovarian stimulation in patients with cancer: impact of letrozole and BRCA mutations on fertility preservation cycle outcomes. Reprod Sci. 2018;25(1):26–32.

    Article  CAS  PubMed  Google Scholar 

  52. Shapira M, Raanani H, Feldman B, Srebnik N, Dereck-Haim S, Manela D, et al. BRCA mutation carriers show normal ovarian response in in vitro fertilization cycles. Fertil Steril. 2015;104(5):1162–7.

    Article  CAS  PubMed  Google Scholar 

  53. Grynberg M, DagherHayeck B, Papanikolaou EG, Sifer C, Sermondade N, Sonigo C. BRCA1/2 gene mutations do not affect the capacity of oocytes from breast cancer candidates for fertility preservation to mature in vitro. Hum Reprod. 2019;34(2):374–9.

    Article  CAS  PubMed  Google Scholar 

  54. Arab S, Tulandi T, Buckett W. Hereditary breast cancer and fertility preservation outcomes. J Assist Reprod Genet. 2022;39(5):1163–8.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Michaan N, Leshno M, Cohen Y, Safra T, Peleg-Hasson S, Laskov I, et al. Preimplantation genetic testing for BRCA gene mutation carriers: a cost effectiveness analysis. Reprod Biol Endocrinol. 2021;19:153.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Lambertini M, Moore HCF, Leonard RCF, Loibl S, Munster P, Bruzzone M, et al. Gonadotropin-releasing hormone agonists during chemotherapy for preservation of ovarian function and fertility in premenopausal patients with early breast cancer: a systematic review and meta-analysis of individual patient-level data. J Clin Oncol. 2018;36(19):1981–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Wong M, O’Neill S, Walsh G, Smith IE. Goserelin with chemotherapy to preserve ovarian function in pre-menopausal women with early breast cancer: menstruation and pregnancy outcomes. Ann Oncol. 2013;24(1):133–8.

    Article  CAS  PubMed  Google Scholar 

  58. •• Buonomo B, Massarotti C, Dellino M, Anserini P, Ferrari A, Campanella M, et al. Reproductive issues in carriers of germline pathogenic variants in the BRCA1/2 genes: an expert meeting. BMC Medicine. 2021;19(1):205. An Italian panel of BRCA1/2 experts presents data and position statements on 8 questions regarding reproduction in this mutation carriers including the risk of pregnancy and fertility treatments with breast cancer risk, the impact of the mutations on fertility, and the impact of treatments on mutation carriers.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Hassett MJ, Somerfield MR, Baker ER, Cardoso F, Kansal KJ, Kwait DC, et al. Management of male breast cancer: ASCO guideline. JCO. 2020;38(16):1849–63.

    Article  Google Scholar 

  60. Campos FAB, Rouleau E, Torrezan GT, Carraro DM, Casali da Rocha JC, Mantovani HK, et al. Genetic landscape of male breast cancer. Cancers (Basel). 2021;13(14):3535.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Evans DGR, Susnerwala I, Dawson J, Woodward E, Maher ER, Lalloo F. Risk of breast cancer in male BRCA2 carriers. J Med Genet. 2010;47(10):710–1.

    Article  CAS  PubMed  Google Scholar 

  62. Ibrahim M, Yadav S, Ogunleye F, Zakalik D. Male BRCA mutation carriers: clinical characteristics and cancer spectrum. BMC Cancer. 2018;18:179.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Gunes S, Al-Sadaan M, Agarwal A. Spermatogenesis, DNA damage and DNA repair mechanisms in male infertility. Reprod Biomed Online. 2015;31(3):309–19.

    Article  CAS  PubMed  Google Scholar 

  64. Simhadri S, Peterson S, Patel DS, Huo Y, Cai H, Bowman-Colin C, et al. Male fertility defect associated with disrupted BRCA1-PALB2 interaction in mice *. J Biol Chem. 2014;289(35):24617–29.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. de Blok CJM, Wiepjes CM, Nota NM, van Engelen K, Adank MA, Dreijerink KMA, et al. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ. 2019;365:l1652.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

Not applicable.

Corresponding author

Correspondence to Kathryn J. Huber-Keener.

Ethics declarations

Competing Interests

Dr. Huber-Keener has nothing to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huber-Keener, K.J. Hereditary Breast Cancer, Genetics, and Fertility Preservation. Curr Breast Cancer Rep 15, 329–336 (2023). https://doi.org/10.1007/s12609-023-00515-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12609-023-00515-0

Keywords

Navigation