Pregnancy After Stage III Breast Cancer

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QUESTION: What about pregnancy after treatment for locally advanced breast cancer?

ANSWER: As far as we know, there is no influence of pregnancy on the natural course of this type of breast cancer—that is, pregnancy will not cause a recurrence. The problem is that stage III breast cancer is more likely to recur or to spread than is stage 0 or stage I breast cancer, with or without a pregnancy. Staging takes into account the size and extent of the cancer in the breast, the presence or absence of lymph node involvement, and possible spread elsewhere. The risk of recurrence depends on other factors besides just staging information. See Understanding Your Big Picture to learn more about hormone receptors, tumor grade, cancer genes, and other factors that affect outcome.

If recurrence happens during pregnancy—in a limited or metastatic way—it is very difficult to deal with. Depending on when during the pregnancy recurrence is to happen, and the nature of the recurrence, treatment options may be limited or they may be accomplished in such a way as to allow the baby to mature and be delivered. The very difficult discussion of "what if the child is left motherless" is something you have to face as a couple. Since the risk of recurrence does go down with time, delaying pregnancy as long as is practical is usually advised. A minimum of 2 years is recommended.

Pregnancy after being diagnosed with breast cancer has been studied by a number of institutions, by looking BACK over records of pre-menopausal breast cancer patients who've either gone on to get pregnant, or not. There's no real way of doing a "clinical trial" to arrive at a scientific answer to this very important personal question. What I mean is that you can't line up women who've had breast cancer, who had similar stages of disease, and who are at the same point in their pregnancy, and compare them to very similar women who are not pregnant. Over time, you see how everyone does, gather the information, analyze it, and write up a report of your findings. Since this type of study isn't realistic, we have to look at small group of women at one hospital, or a large number of women in a particular population over time (such as in the whole country).

The most recent report on this issue was at the May 2001 American Society of Clinical Oncology meeting. The findings were consistent with other studies: Pregnancy was not associated with an increased risk of recurrence or worsened survival in patients previously treated for breast cancer. The researchers did notice that the women who had become pregnant, however, tended to have had earlier-stage disease. That's not surprising: Early stage is more common than later stage, your prognosis influences your decision to get pregnant (thus women with early-stage disease are more likely to choose to have a child, women with later-stage disease less likely to make such a long-term commitment), women with early-staged disease are more likely to survive to the point when it's appropriate to think about getting pregnant.

Clearly pregnancy—having a family—is an important, emotionally charged issue, even if breast cancer hasn't touched your life. You need to review all of the considerations with your doctors. Most recommend that you wait for two years after treatment is finished before trying to get pregnant.

—Anne Moore, M.D.

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