Pregnancy increases chance of recurrence?


Question from Website Question: Does getting pregnant after breast cancer diagnosis/treatment really increase the chances of recurrence?
Answers - Kutluk Oktay, M.D. More and more studies suggest that if the cancer was in its earlier stages pregnancy after breast cancer does not seem to have an effect on recurrence. Less is known about advanced cancers, and one of the reasons for that is that women with advanced stage cancers tend to attempt pregnancy less than women with less advanced cancers.
Marisa Weiss, M.D. Is there a way to establish a registry study so we, as doctors, can learn more about these important issues a little faster?
Kutluk Oktay, M.D. There is definitely a huge need and practical feasibility. We should establish such a registry, and I think it's feasible. We're almost doing it now. We refer a significant number of these patients, and it would be a great task and very useful.

The reason why many women are concerned about pregnancy increasing the risk of recurrence is that breast cancer by and large is dependent on estrogen to grow. Even the estrogen-receptor-negative cancers will have some percentage of estrogen receptors. A low level of these receptors may not be that important if you're dealing with normal levels of estrogen. But during pregnancy, those estrogen levels may be 100 times normal. So the concern is that if your tumor can feed on estrogen, if there are cancer cells floating around, will the high levels of hormones during pregnancy make them grow?

But there are probably hundreds of hormones that also increase during pregnancy. These extra hormones could be canceling each other out, so the estrogen will not necessarily have an effect. Pregnancy is not, therefore, a situation where you just have high estrogen and that is guaranteed to revive cancer cells.
Marisa Weiss, M.D. Just for clarification, after surgery, chemotherapy, and radiation, the hope is that you are cancer-free. What we're talking about here is the situation where maybe there could possibly be some cancer cells lingering in the body that you might not know about. If you are, in fact, cancer free, then all the different hormones that increase during pregnancy will not have any effect on recurrence. But if there are some cancer cells still left in your body despite your prior treatment, then there is this theoretical concern that all the different hormones that rise during pregnancy may stimulate growth of those cells.

The concern is not that the hormones of pregnancy will start a brand new set of cancer cells, but rather that they may stimulate cells that may be left in the body. But, as Dr. Oktay noted, research has shown that in early-stage breast cancer there does not seem to be an increased risk of recurrence with pregnancy.
Leslie R. Schover, Ph.D. If they have a pregnancy before age 40, women who are carriers of the BRCAI or BRCA2 mutations may be more likely to get breast cancer. But they are a small percentage of women, and they're women who carry the mutation but have not had breast cancer.

On Wednesday, August 18, 2004, our Ask-the-Expert Online Conference was called Pregnancy and Fertility Issues. Kutluk Oktay, M.D., Leslie Schover, Ph.D., and moderator Marisa Weiss, M.D. answered your questions about pregnancy and fertility before, during, and after breast cancer treatment, as well as the options of adoption and gestational carriers (surrogate mothers).

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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