Abstract
Studies have shown that an increasing proportion of young women are diagnosed with breast cancer before completing their families. However, there is a dogma that subsequent pregnancy could be detrimental on breast cancer outcome. Over the past 40 years, several studies were published showing that pregnancy does not appear to increase the risk of recurrence. More recently, we have shown in a large international trial that even in patients with a history of endocrine-sensitive disease, subsequent pregnancy appears to be safe. However, with the increasing duration of adjuvant endocrine therapies (sometimes up to 10 years), it is mostly unfeasible to wait that long to consider a pregnancy. This chapter discusses how to counsel and manage these situations. It also discusses pregnancy and fetal risks along with managing pregnancies occurring accidentally during adjuvant endocrine treatment.
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References
Rosenberg SM, Newman LA, Partridge AH. Breast cancer in young women: rare disease or public health problem? JAMA Oncol. 2015;1:877–8.
Azim HA Jr, Peccatori FA, de Azambuja E, et al. Motherhood after breast cancer: searching for la dolce vita. Expert Rev Anticancer Ther. 2011;11:287–98.
Partridge AH, Gelber S, Peppercorn J, et al. Web-based survey of fertility issues in young women with breast cancer. J Clin Oncol. 2004;22:4174–83.
Ruddy KJ, Gelber SI, Tamimi RM, et al. Prospective study of fertility concerns and preservation strategies in young women with breast cancer. J Clin Oncol. 2014;32:1151–6.
Lambertini M, Di Maio M, Pagani O, et al. The BCY3/BCC 2017 survey on physicians’ knowledge, attitudes and practice towards fertility and pregnancy-related issues in young breast cancer patients. Breast. 2018;42:41–9.
Collins LC, Marotti JD, Gelber S, et al. Pathologic features and molecular phenotype by patient age in a large cohort of young women with breast cancer. Breast Cancer Res Treat. 2012;131:1061–6.
Azim HA Jr, Michiels S, Bedard PL, et al. Elucidating prognosis and biology of breast cancer arising in young women using gene expression profiling. Clin Cancer Res. 2012;18:1341–51.
Pagani O, Regan MM, Walley BA, et al. Adjuvant exemestane with ovarian suppression in premenopausal breast cancer. N Engl J Med. 2014;371:107–18.
Francis PA, Regan MM, Fleming GF. Adjuvant ovarian suppression in premenopausal breast cancer. N Engl J Med. 2015;372:1673.
Davies C, Pan H, Godwin J, et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet. 2013;381:805–16.
Stensheim H, Cvancarova M, Moller B, et al. Pregnancy after adolescent and adult cancer: a population-based matched cohort study. Int J Cancer. 2011;129:1225–36.
Peccatori FA, Azim HA Jr, Orecchia R, et al. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi160–70.
Azim HA Jr, Santoro L, Pavlidis N, et al. Safety of pregnancy following breast cancer diagnosis: a meta-analysis of 14 studies. Eur J Cancer. 2011;47:74–83.
Biglia N, Torrisi R, D’Alonzo M, et al. Attitudes on fertility issues in breast cancer patients: an Italian survey. Gynecol Endocrinol. 2015;31:458–64.
Azim HA Jr, Kroman N, Paesmans M, et al. Prognostic impact of pregnancy after breast cancer according to estrogen receptor status: a multicenter retrospective study. J Clin Oncol. 2013;31:73–9.
Lambertini M, Kroman N, Ameye L, et al. Long-term safety of pregnancy following breast cancer according to estrogen receptor status. J Natl Cancer Inst. 2018;110:426–9.
Metzger-Filho O, Sun Z, Viale G, et al. Patterns of recurrence and outcome according to breast cancer subtypes in lymph node-negative disease: results from international breast cancer study group trials VIII and IX. J Clin Oncol. 2013;31:3083–90.
Pagani O, Ruggeri M, Manunta S, et al. Pregnancy after breast cancer: are young patients willing to participate in clinical studies? Breast. 2015;24:201–7.
Huiart L, Bouhnik AD, Rey D, et al. Early discontinuation of tamoxifen intake in younger women with breast cancer: is it time to rethink the way it is prescribed? Eur J Cancer. 2012;48:1939–46.
Cluze C, Rey D, Huiart L, et al. Adjuvant endocrine therapy with tamoxifen in young women with breast cancer: determinants of interruptions vary over time. Ann Oncol. 2012;23:882–90.
Langagergaard V, Gislum M, Skriver MV, et al. Birth outcome in women with breast cancer. Br J Cancer. 2006;94:142–6.
Dalberg K, Eriksson J, Holmberg L. Birth outcome in women with previously treated breast cancer—a population-based cohort study from Sweden. PLoS Med. 2006;3:e336.
Azim HA Jr, Metzger-Filho O, de Azambuja E, et al. Pregnancy occurring during or following adjuvant trastuzumab in patients enrolled in the HERA trial (BIG 01-01). Breast Cancer Res Treat. 2012;133:387–91.
Lambertini M, Martel S, Campbell C, et al. Pregnancies during and after trastuzumab and/or lapatinib in patients with human epidermal growth factor receptor 2-positive early breast cancer: analysis from the NeoALTTO (BIG 1-06) and ALTTO (BIG 2-06) trials. Cancer. 2019;125:307–16.
Dolk H, Loane M, Garne E. The prevalence of congenital anomalies in Europe. Adv Exp Med Biol. 2010;686:349–64.
Lambertini M, Del Mastro L, Pescio MC, et al. Cancer and fertility preservation: international recommendations from an expert meeting. BMC Med. 2016;14:1.
Sharma S, Rani G, Bose G, et al. Tamoxifen is better than low-dose clomiphene or gonadotropins in women with thin endometrium (<7 mm) after clomiphene in intrauterine insemination cycles: a prospective study. J Hum Reprod Sci. 2018;11:34–9.
Braems G, Denys H, De Wever O, et al. Use of tamoxifen before and during pregnancy. Oncologist. 2011;16:1547–51.
Tewari K, Bonebrake RG, Asrat T, et al. Ambiguous genitalia in infant exposed to tamoxifen in utero. Lancet. 1997;350:183.
Cullins SL, Pridjian G, Sutherland CM. Goldenhar’s syndrome associated with tamoxifen given to the mother during gestation. JAMA. 1994;271:1905–6.
Berger JC, Clericuzio CL. Pierre Robin sequence associated with first trimester fetal tamoxifen exposure. Am J Med Genet A. 2008;146A:2141–4.
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Azim, H.A. (2020). Safety and Challenges of Pregnancy in Women with a History of Endocrine-Sensitive Breast Cancer. In: Azim Jr, H., Demeestere, I., Peccatori, F. (eds) Fertility Challenges and Solutions in Women with Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-24086-8_2
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DOI: https://doi.org/10.1007/978-3-030-24086-8_2
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