Breast cancer is the most common malignancy diagnosed in women of childbearing age. A breast cancer diagnosis in this young patient population can be uniquely complex to navigate when considering the potential impact of fertility loss associated with specific gonadotoxic therapies. Another unique challenge for young breast cancer patients is pregnancy-associated breast cancer (PABC), which occurs in approximately 1 of every 3000 pregnancies. Pregnancy adds a layer of complexity to breast cancer treatment planning as many therapies can affect the developing fetus. These two clinical challenges require nuanced multidisciplinary approaches to facilitate optimal treatment outcomes. We sought to review and summarize the management strategy options for both fertility preservation and PABC.
A guideline and literature review was performed for fertility preservation, young patients with breast cancer, and pregnancy-associated breast cancer.
Fertility preservation options, both established and experimental, are detailed. Suggested clinical practice guidelines for PABC are also presented, which delineate breast cancer treatment recommendations based on pregnancy trimester.
A multidisciplinary approach to patient care, including oncologists and early referral to reproductive specialists, can provide young breast cancer patients with options for fertility preservation. Under the guidance of a multidisciplinary treatment team, PABC can also be diagnosed and treated to permit the best possible outcomes for the mother and the developing fetus.
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The authors thank Zachary Pascoe for helpful discussions regarding manuscript preparation. The authors acknowledge financial support from the NIH R01CA214384 (to J. S. Jeruss), A Sister’s Hope Foundation, (J. S. Jeruss), and NIH T32CA009672 (J. S. Jeruss and P. Kandagatla).
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Shah, N.M., Scott, D.M., Kandagatla, P. et al. Young Women with Breast Cancer: Fertility Preservation Options and Management of Pregnancy-Associated Breast Cancer. Ann Surg Oncol 26, 1214–1224 (2019). https://doi.org/10.1245/s10434-019-07156-7