Breast Cancer, BRCA Mutations, and Attitudes Regarding Pregnancy and Preimplantation Genetic Diagnosis

Woodson, Ashley H.; Muse, Kimberly I.; Lin, Heather; Jackson, Michelle; Mattair, D.; Schover, Leslie R.; Woodard, Terri L.; McKenzie, Laurie J.; Theriault, Richard L.; Hortobágyi, Gabriel N.; Arun, Banu K.; Peterson, Susan K.; Profato, Jessica; Litton, Jennifer K.

doi:10.1634/theoncologist.2014-0057

Cited by 23 publications

(14 citation statements)

References 43 publications

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“…To begin, our findings reinforce previous research articulating a tension between cancer risk management (i.e., preventative surgeries) and life goals (i.e., having children, Donnelly et al 2013;Rubin et al 2014;Werner-Lin 2008), yet reveals previvors' willingness to push their preventative surgeries back in order to have (more) children. This is in contrast to previous research that has found that women who test positive for a BRCA mutation were less likely to want more children after learning their genetic test results (Smith et al 2004;Woodson et al 2014). This finding also relates to other reproductive decision-making in other genetic contexts.…”

Section: Discussioncontrasting

confidence: 89%

“It was an Emotional Baby”: Previvors’ Family Planning Decision‐Making Styles about Hereditary Breast and Ovarian Cancer Risk

Dean

Rauscher

2017

Journal of Genetic Counseling

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Women who test positive for a BRCA genetic mutation are at an increased risk for developing hereditary breast and ovarian cancer and have a 50% chance of passing on their genetic mutation to their children. The purpose of this study was to investigate how women who test positive for a BRCA mutation but have not been diagnosed with cancer make decisions regarding family planning. Analysis of interviews with 20 women revealed they engage in logical and emotional decision-making styles. Although women want to be logical to reduce their hereditary cancer risk, emotions often complicate their decision-making. Women experience fear and worry about a future cancer diagnosis, yet also desire to create a family, particularly having children through natural conception. That is, women negotiate having preventative surgeries in a logical doctor-recommended timeframe but also organize those decisions around emotional desires of motherhood. Overall, this study demonstrates the complex decisions women who test positive for a BRCA mutation must make in regards to genetic testing timing, family planning, and overall quality of life.

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Section: Discussioncontrasting

confidence: 89%

“It was an Emotional Baby”: Previvors’ Family Planning Decision‐Making Styles about Hereditary Breast and Ovarian Cancer Risk

Dean

Rauscher

2017

Journal of Genetic Counseling

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“…In a case-control study comparing fertility desires of 25 BRCA1 carriers vs. 62 non-carriers, Smith et al reported that female carriers were significantly less likely to report a desire for future children (Smith et al, 2004). A survey study found that following disclosure of a BRCA mutation, women (especially those >36 years of age) were less interested in future childbearing (Woodson et al, 2014). In contrast, very few of the women in our study whose families were not complete at the time of survey decided against having children in light of their carrier status.…”

Section: Discussionmentioning

confidence: 99%

Reproductive Decision‐Making in Women with BRCA1/2 Mutations

Chan

Johnson

Sammel

et al. 2016

Journal of Genetic Counseling

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Expanded genetic testing of BRCA mutations has led to identification of more reproductive-aged women who test positive for the mutation which might impact attitudes and decisions about relationships, childbearing and the use of preimplantation genetic diagnosis (PGD) and prenatal diagnosis (PND). A cross-sectional survey was administered to 1081 self-reported BRCA carriers to investigate how knowledge of BRCA status influences these issues. The mean age at BRCA test disclosure was 44 years and 36% reported a personal history of cancer. Of 163 women who were unpartnered, 21.5% felt more pressure to get married. Of 284 women whose families were not complete, 41% reported that carrier status impacted their decision to have biological children. Women with a history of cancer were more likely to report that knowledge of BRCA+ status impacted their decision to have a child (OR 1.8, 95% CI 1–3.2). Fifty-nine percent thought PGD should be offered to mutation carriers and 55.5% thought PND should be offered. In conclusion, knowledge of BRCA status impacts attitudes regarding relationships and childbearing, and most carriers believe that PGD and PND should be offered to other carriers. This study suggests that BRCA carriers desire and would benefit from reproductive counseling after test disclosure.

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“…Before the start of any systemic therapy, all AYAs with breast cancer should be offered referral to a reproductive endocrinologist for either embryo or oocyte cryopreservation. Preimplantation genetic diagnosis, selecting unaffected embryos for implantation, is an option for carriers of BRCA mutations or other cancer predisposition syndromes . Ovarian suppression with goserelin during chemotherapy is an option for AYAs with hormone‐receptor‐negative breast cancer, decreasing the incidence long‐term ovarian failure and possibly improving pregnancy outcomes …”

Section: Special Issues For Ayas With Breast Cancermentioning

confidence: 99%

Breast cancer in adolescents and young adults

Johnson

Anders

Litton

et al. 2018

Pediatric Blood & Cancer

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161

117

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Breast cancer is the most common cancer of adolescents and young adult (AYA) women aged 15 to 39 years, accounting for 5.6% of all invasive breast cancer in women. In comparison with older women, AYAs are more likely to have familial cancer predisposition genes, larger breast tumors, unfavorable biological characteristics, distant metastatic disease at diagnosis, and adverse outcome. Endocrine therapy and some chemotherapy recommendations differ between young and older women. AYAs require coordinated multidisciplinary care, treatment regimens that minimize late effects such as premature menopause and osteoporosis, and proactive management of psychological and sexual health during and after cancer treatment.

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Breast Cancer, BRCA Mutations, and Attitudes Regarding Pregnancy and Preimplantation Genetic Diagnosis

Cited by 23 publications

References 43 publications

“It was an Emotional Baby”: Previvors’ Family Planning Decision‐Making Styles about Hereditary Breast and Ovarian Cancer Risk

“It was an Emotional Baby”: Previvors’ Family Planning Decision‐Making Styles about Hereditary Breast and Ovarian Cancer Risk

Reproductive Decision‐Making in Women with BRCA1/2 Mutations

Breast cancer in adolescents and young adults

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