Effects of pregnancy after treatment for breast carcinoma on survival and risk of recurrence

Blakely, L. Johnetta; Buzdar, Aman U.; Lozada, Jose A.; Shullaih, Samer A.; Hoy, Emma; Smith, Terry L.; Hortobágyi, Gabriel N.

doi:10.1002/cncr.11929

Cited by 166 publications

(112 citation statements)

References 30 publications

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“…102 In fact, women with full-term pregnancies had a reduced risk of death. Additionally, the risk of recurrence did not appear to increase, [98][99][100][101] and the 5-year survival rate was 100% when the pregnancy occurred 1 to 2 years after treatment. 103,104 However, caution must be used when interpreting the results because a "healthy mother effect" may exist-that is, only the healthier breast cancer survivors may attempt to conceive.…”

Section: Effect Of Pregnancymentioning

confidence: 91%

“…96,97 The risk of breast cancer recurrence does not appear to increase with pregnancy after breast cancer treatment. [98][99][100][101] A large Danish study of 371 women who were pregnant after breast cancer showed no increase in the risk of cancer recurrence or worsening of prognosis with pregnancy. 102 In fact, women with full-term pregnancies had a reduced risk of death.…”

Section: Effect Of Pregnancymentioning

confidence: 99%

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Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Bakkum-Gamez

Laughlin

Jensen

et al. 2011

Mayo Clinic Proceedings

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). © 2011 Mayo Foundation for Medical Education and ResearchB reast cancer is the leading cause of cancer death in women in the United States who are aged 20 to 59 years. 1 In 2010, an estimated 207,090 new cases of breast cancer were identified in the United States. 2 Although breast cancer risk increases with age, approximately 35% of breast cancers occur during the reproductive and perimenopausal years. 3 The 5-year relative survival rate for women of all ages with breast cancer diagnosed between 1999 and 2005 is 89%. 3 Of the premenopausal breast cancers diagnosed, approximately 58% are both estrogen receptor (ER) and progesterone receptor (PR) positive, 6% are ER positive only, 17% are PR positive only, and 20% are both ER and PR negative. 4 The management and treatment of breast cancer in premenopausal women can affect menstruation, reproduction, and gynecologic health. Breast cancer treatment can have a marked affect on fertility in women who have delayed childbearing and have fewer remaining reproductive years. Among premenopausal women with breast cancer, more than 50% wish to retain their fertility. 5 AUB = abnormal uterine bleeding; E2 = estradiol; EA = endometrial ablation; EC = endometrial cancer; ER = estrogen receptor; FDA = Food and Drug Administration; GnRH = gonadotropin-releasing hormone; IUD = intrauterine device; LNG = levonorgestrel; NSAID = nonsteroidal anti-inflammatory drug; PR = progesterone receptor; SHBG = sex hormone-binding globulin gynecologic issues and conditions are prevalent in reproductive-age women. In the general population, more than 30% of reproductive-age women fulfill criteria for the diagnosis of menorrhagia, 6 25% have symptomatic fibroids, 7 and nearly 67% have an underlying uterine disorder with potential to cause abnormal uterine bleeding (AUB). 8 Among premenopausal women with breast cancer, management of menstrual disorders, contraception, vasomotor symptoms, and fertility presents a challenge. Common and effective hormonal options are less well studied in this population because of significant concern about recurrence of breast cancer. Herein,we present the challenges and discuss management options for young women with breast cancer who present with various common gynecologic conditions.Articles for this review were identified by searching the PubMed database with no date limitations. PREMENoPAUSAL SEx STERoIDS AND THEIR PHARMACoLoGyPhysiologically, premenopausal women with regular cycles have cyclic variation in levels of estradiol (E2) (15-350 pg/ mL [to convert to pmol/L, multiply by 3.671]) and progesterone (0.2-27 ng/mL [to convert to nmol/L, multiply by 3.18]). These "free" (unbound) hormones are biologically active and can enter a target cell and activate its receptor.

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Section: Effect Of Pregnancymentioning

confidence: 91%

Section: Effect Of Pregnancymentioning

confidence: 99%

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Bakkum-Gamez

Laughlin

Jensen

et al. 2011

Mayo Clinic Proceedings

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“…However, the epidemiologic evidence of the effect of breast cancer on birth outcome is limited. The few studies of women who were diagnosed with breast cancer before pregnancy have focused on maternal prognosis (Ribeiro et al, 1986;Sutton et al, 1990;Dow et al, 1994;Malamos et al, 1996;Kroman et al, 1997;Velentgas et al, 1999;Blakely et al, 2003). Thus, no population-based cohort study of birth outcome in women diagnosed with breast cancer before pregnancy has been published.…”

mentioning

confidence: 99%

Birth outcome in women with breast cancer

et al. 2005

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We investigated whether maternal breast cancer affects birth outcome in a nationwide cohort study of 695 births from 1973 to 2002 of women with breast cancer with respect to preterm birth, low birth weight at term, stillbirth and congenital abnormalities as well as mean birth weight, compared with the outcomes of 33 443 births from unaffected mothers. There was no excess risk of adverse birth outcome for the 216 newborns of women with breast cancer before pregnancy. Stratification by mother's treatment did not change the results. For 37 newborns of women diagnosed during pregnancy, the prevalence ratio (PR) of preterm birth was 8.1 (95% confidence interval (CI): 3.8 -17). However, 10 of the 12 preterm deliveries among these women were elective early deliveries. Among 442 births of women diagnosed in the 2 years from time of delivery, the PR of preterm birth was 1.4 (95% CI: 1.0 -2.0), and the PR of low birth weight at term for boys was 2.9 (95% CI: 1.3 -6.3). Overall, our results are reassuring regarding the risks of adverse birth outcome for breast cancer patients.

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“…However, the study reported a 40% rate of abnormal pregnancies, mainly of premature birth and low birth weight, both of which were attributed to dysfunction of the uterine hormonal gestational milieu. In a study by Blakely et al [24] the high rate of miscarriage (29%) has been explained by the older age of the women, and changes to ovarian function that can occur after chemotherapy. Unfortunately, the delayed effects on offspring remain to be determined on those who conceive either whilst the mother is undergoing chemotherapy or subsequently.…”

Section: Chemotherapymentioning

confidence: 99%