Pregnancy okay for triple-negative survivors?


Question from Asics Girl: Since triple-negative breast cancer is not fueled by hormones, is it safe for a triple-negative survivor to become pregnant after treatment or could it start metastasis to occur?
Answers - Beth Baughman DuPree, M.D., F.A.C.S. Pregnancy after breast cancer is always one of the most difficult topics to discuss with patients. First and foremost, the treatment of the cancer with surgery, chemotherapy, and radiation needs to be the first and foremost important aspect in this discussion, as caring for the woman who has the breast cancer and treating her appropriately to allow her to have the greatest chance for long term disease-free survival is of the utmost importance. Once a patient has completed her treatment, it is recommended in my practice, as well as those of the medical oncologists I work with, that the patient wait for at least a 2-3 year period after treatment of their cancer prior to initiating attempts to become pregnant. If I have patients in their mid-30s who are about to undergo chemotherapy, I will discuss with them prior to their treatment what options would be available to them to help to maintain fertility: to potentially perform egg retrieval and fertilization prior to their treatment if pregnancy is of utmost importance to them after completion of their chemotherapy. In women who are estrogen-receptor positive, the concern about pregnancy immediately after treatment is from the overabundance of hormones such as estrogen and progesterone that are produced during pregnancy that could potentially fuel any cancer cells that may have been left over from the initial cancer. In my patients who are estrogen-receptor positive in a premenopausal setting I recommend that they complete their 5 years of tamoxifen, but there are many medical oncologists who would, after 2 years, allow the patient to go off their tamoxifen to initiate pregnancy. There are many factors beside just estrogen-receptor positivity that would need to be taken into account when considering pregnancy after breast cancer. Each patient needs to be counseled individually and when all of the risks, benefits, and potential rewards of the pregnancy are discussed, that couple can then make an educated decision about how and when to proceed with pregnancy.
George Sledge, M.D. I agree with everything Dr. Dupree mentioned. I approach things slightly differently in my clinic. The first question I think we need to ask is whether a pregnancy subsequent to breast cancer diagnosis increases the risk of recurrence of that cancer. While it is very difficult to say for certain, such evidence as we have suggests that there is not likely to be a major increase in risk of recurrence. The second question is a much more difficult one to my mind, and that is to say should a patient become pregnant knowing that it is possible that the child she brings into this world may grow up without a mother? This gets to the question of risk of recurrence, and in particular the risk of the recurrence that a woman would have with or without a pregnancy. As Dr. Dupree mentioned, one of the reasons for waiting for a pregnancy, especially in triple-negative breast cancer survivors, is that the greatest risk of recurrence in triple-negative breast cancer occurs relatively early on, in the first few years after diagnosis. Other factors that help determine the risk of recurrence are classic factors such as tumor size and number of lymph nodes involved. The patient and her spouse therefore need to consider what degree of risk they are willing to accept prior to a patient becoming pregnant. This is often one of the more difficult discussions that families and physicians can ever have, but certainly a very important one.

On Wednesday, July 16, 2008 our Ask-the-Expert Online Conference was called Triple-Negative Breast CancerGeorge Sledge, M.D. and Beth Baughman DuPree, M.D., F.A.C.S. answered your questions about triple-negative breast cancer and its treatment.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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