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Mrs. Christina Tsionou, Gynecologist – Breast Surgeon and Director of the 1st MITERA Breast Clinic, speaks on ygeiamou about the preservation of fertility and especially about the safety of pregnancy in women after being diagnosed with breast cancer
THE Breast cancer is more frequent malignancy in women under 40 years of age and therefore of reproductive age. Many patients at this age have not completed their family and the question of preserving fertility arises. But we are mainly concerned with the safety of the pregnancy for the patient in terms of the recurrence of the disease and therefore survival as well as the effect of the treatments on the outcome of the pregnancy and the health of the newborn.
The discussion of fertility preservation methods is initially done before the start of breast cancer treatments. These include the preservation- freezing of embryos, eggs or ovarian tissue. Egg retrieval is done by inducing ovulation with specialized protocols that also use drugs to treat breast cancer and are safe. If this cannot be done we stop the period during the chemotherapy with injections, although it is not considered the best way because even if the period comes after the treatments the fertility may have been affected.
Another problem we face especially in women who will take hormone therapy for 10 years, even if they have not had to do chemotherapy, is the delay in starting to try to conceive. It is also not known how long after diagnosis it is safe to attempt pregnancy and whether it is safe to temporarily stop treatment to achieve this.
Previous retrospective studies they show us that pregnancy does not affect survival compared to other women also with breast cancer who did not become pregnant. This was seen in all types of breast cancer. Of course, this may not be completely accurate and pregnancy should be attempted by patients with a better prognosis. In fact, a pooled analysis of 14 retrospective studies (1) showed that patients who became pregnant had a 41% reduced mortality compared to those who did not have a pregnancy. Of course, as we said, this can be a result of selection. The safe interval after diagnosis in the older studies was two years.
The first and long-awaited prospective study designed to specifically answer these questions, POSITIVE (2), was recently announced. In general, prospective studies are more reliable than the retrospective ones mentioned above. This study included patients up to 42 years of age, with hormone-dependent breast cancer. They had taken hormone therapy for 18-30 months and stopped it 3 months before attempting pregnancy and up to 2 years. During this time, pregnancy was attempted, childbirth took place and some breastfed until they were 2 years old. Then they continued the hormone therapy until the completion of a total of 10 years. A total of 497 patients were studied and the comparison was made with a group of premenopausal women who took part in two other well-designed studies.
In the 3-year analysis, disease recurrence was observed in 8.9%, compared to 9.2% in the comparison group. Metastases were 4.5% in the pregnancy group compared to 5.9% in the other group.
Pregnancies were more in younger women <35, who achieved pregnancy in 85.7%, while in the age group 40-42 in 52.7%. No congenital anomalies were observed in the newborns, although caesarean sections and premature births were more common. Therefore, it appears in this prospective study that in selected cases with hormone-dependent cancers, temporary cessation does not affect survival and is safe for the newborn.
Of course, we have to take into account the short follow-up period, 3 years, and the good biological type of the patients, although there were also stage 2 or 3 patients. We need a longer period, 10 years, to draw safe conclusions, but at least the results so far are quite encouraging. For the other biological subtypes for which we do not have new data, we recommend that they wait approximately 5 years before attempting pregnancy, provided they are free of disease.
Patients must be systematically and carefully informed about these data, about the concerns we have, so that they can make the right decision. We have to inform them and support them.
October is Breast Cancer Awareness Month and a reminder that prevention and early screening save lives. HYGEIA and MITERA, with their new campaign, try to remind every woman how important breast screening is in preventing the disease, asking the simple question: “Have you been checked?”. So let’s make prevention our ally!
Discover more here.