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SABCS 2020: Pregnancy After a Breast Cancer Diagnosis
Matteo Lambertini, M.D., Ph.D.
January 13, 2021

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Fertility after breast cancer treatment is an important issue for many, many younger women diagnosed with breast cancer. At the 2020 San Antonio Breast Cancer Symposium, research was presented showing that while breast cancer survivors of child-bearing age are less likely to get pregnant than the average woman, most have healthy babies and pregnancy has no effect on their long-term survival. Dr. Matteo Lambertini, adjunct professor of medical oncology at the University of Genova - IRCCS Policlinico San Martino Hospital, is corresponding author of the study.

Listen to the episode to hear Dr. Lambertini explain:

  • why the researchers did the study
  • a summary of the study and the results
  • why it is important for women and doctors to know that pregnancy after breast cancer treatment is safe for both a woman and her baby
  • his advice to young women who have been diagnosed with breast cancer and want to have a child after treatment

Running time: 11:14

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Jamie DePolo: Hello, thanks for listening. Fertility after breast cancer treatment is an important issue for many, many younger women diagnosed with breast cancer. At the 2020 San Antonio Breast Cancer Symposium, research was presented showing that while breast cancer survivors of childbearing age are less likely to get pregnant than the average woman, most have healthy babies and pregnancy has no effect on their long-term survival. Dr. Matteo Lambertini, adjunct professor of medical oncology at the University of Genova IRCCS Policlinico San Martino Hospital, who is corresponding author of this study, joins us today to talk about the results. 

Dr. Lambertini, welcome to the podcast. It’s so nice to talk to you again. 

Dr. Matteo Lambertini: Thank you very much for having me here again. It’s my pleasure. Thank you. 

Jamie DePolo: So to start, could you please give us an overview of this study? Why did you want to do this research? 

Dr. Matteo Lambertini: Pregnancy-related issues are of high importance for our young breast cancer patients, so this is the first and main reason why to do research in this topic. And the second one is because survivorship issues are greatly important. And what we are currently seeing is that the 21st century an important issue in cancer care is also maintaining quality of life after treatment, and not only anti-cancer treatment instead. 

And so for young women, as mentioned, fertility and pregnancy issues are of high importance, and in this specific regard there are still a lot of misconceptions among physicians that we have tried, and we are trying, to disband, producing evidence and data to support the safety of these pregnancies. 

Jamie DePolo: Okay, so can you give us an overview of the study? What did you actually do? 

Dr. Matteo Lambertini: At the 2020 San Antonio Breast Cancer Symposium we presented a large international meta analysis, meaning that we pulled together the results of 39 studies that address the safety of pregnancy after breast cancer, so women with a diagnosis of breast cancer that, years after end of treatment, decide to try to conceive. 

In this meta analysis, we address three main objectives. The first one, we wanted to see chances of post-treatment pregnancies. And we observed that breast cancer survivors, as compared to healthy women from the general population, had around 60% lower chances to have a subsequent pregnancy. And one of the potential explanations is what I have just mentioned, that there are still safety concerns around this topic, and the other two objectives, I hope that we have disbanded the safety concern. 

The second objective was indeed to evaluate the safety on the baby’s side and the third objective on the mother’s side. On the baby side what we have observed is that for breast cancer survivors as compared to pregnancy in healthy women from the general population, there’s a higher risk of some pregnancy complications like caesarean section, pre-term delivery, small gestational age, and low birth weight. However, importantly, there is no increased risk for the majority of the other complications, including no increased risk of major malformation as compared to the general population. So, the main message from this analysis is that babies are safe, but we have to monitor more closely these pregnancies. 

And the final objective is on the maternal safey. So we wanted to look if pregnancy is detrimental, can have a negative effect, on the survival of the patient, and it is one of the main concerns that we have as oncologists. And what we have observed is there’s a very strong signal that pregnancy is not detrimental and actually seems to be the other way around, the patients with a pregnancy following breast cancer tend to have better survival outcomes as compared to patients without a subsequent pregnancy. This is very important. 

Jamie DePolo: Yes, and that’s also very interesting. Now, one important point I think that we have to talk about is that in this study, so you said that women who had been diagnosed with breast cancer were 60% less likely than an average woman to get pregnant. But you also didn’t know, I believe you pointed this out in the study, that whether all those women who had been diagnosed with breast cancer wanted to get pregnant. So, it could be a little misleading there. Is that true? 

Dr. Matteo Lambertini: Thanks a lot for the question. This is a very important point to address. So, saying that there’s a 60% lower chance can be misleading in some sense, as you have just discussed. 

So what we do not know from these studies is actually how many women have tried to get pregnant, so we actually do not know this denominator so we cannot address that question. However, there some of the studies that we have included in our meta analysis that reported this data, and here we can say that around half of young women that tried for a pregnancy are able, actually, to have the pregnancy. In most of these cases, these are natural conceptions, so there is no need of ART, assisted reproductive technology, which is an important message. 

On the other side, another important message to stress here has also shown that some of the studies, including the meta analysis, that there are some patients that actually did not want to have a pregnancy, but then got pregnant. So, another important issue that we have to discuss in our clinics, and we tend to forget about this issue, is also contraception, which is important in young women. And there are some special considerations in breast cancer survivors for type of contraception because, of course, we can’t give hormones and hormone-based contraception. 

Jamie DePolo: Okay, thank you. Now, I know you've conducted several other studies on pregnancy after breast cancer treatment, including using ovarian suppression to preserve fertility and how safe it is for a woman with a BRCA mutation to get pregnant after treatment. And I think you also looked at physician’s attitudes towards these issues, because that’s very important, too, because if a doctor’s telling a woman, “No, you shouldn’t get pregnant,” that’s certainly going to affect her choices. 

So, you're looking at all these different aspects. What would be your advice to a young woman who’s been diagnosed with breast cancer who wants to have a child after treatment? What are your suggestions for steps she might take to give herself the best chance of getting pregnant? 

Dr. Matteo Lambertini: Very important point. The main message is what our current guidelines on fertility and pregnancy, the related issues in cancer survival, are telling us, and this recommendation is that we need to provide a proper oncofertility counseling at the time of diagnosis — actually as soon as possible after diagnosis — to all the young women with newly diagnosed cancer, irrespective of stage, parity, and their family planning. So, we need to inform them that the treatment we give are associated with a certain risk of gonadotoxicity, so of having a negative effect on ovarian function and affecting the outcomes in these cases. 

Patients interested in potentially having a pregnancy following treatment completion should be referred to fertility centers as soon as possible after diagnosis and before starting anti-cancer treatment, because fertility-preservation strategies, specifically embryo cryopreservation should be performed before starting chemotherapy, not after. The success if done after can be lower, so it’s important to have had introspection into fertility. 

And it’s giving also the message that in most of the cases there is no need for these women, following treatment completion, to go back to the fertility unit because they are able to conceive naturally. But if they have unsuccess with fertility, they might have some frozen material that can help them increase the chance of future pregnancy. 

So, the main message is to discuss this topic, and this is the message that women should have, but also as physicians, and as medical oncologists, should really have. Nowadays this is mandatory, so it is something we have to discuss, and if we are not discussing that our patient should possibly bring this topic up. 

Jamie DePolo: Okay, so if a woman’s doctor, say, doesn't bring it up, she should be her own advocate and definitely ask her doctor about it? 

Dr. Matteo Lambertini: Yes. Definitely. This is something that has to be discussed. As mentioned, it’s mandatory as per guidelines, and as our guidelines are telling us, this has to be discussed also irrespective of stage at the time of diagnosis. So women should be informed that infertility is a potential side effect of anti-cancer treatment, and there are strategies to try to reduce the burden of this side effect. So discussion is very important. 

And as we’re showing in one of our surveys among breast cancer specialists, unfortunately up to 30%, for example, are not sure that pregnancy after breast cancer is safe. And now we have a lot of data, in the one that we have presented at the San Antonio Breast Cancer Symposium, that are reassuring in this regard, so there is evidence to counsel our patients. So, if the physician is not doing that, maybe it can be asked to someone else because this is something that needs to be discussed. 

Jamie DePolo: Wonderful. Dr. Lambertini, thank you so much. I really appreciate your insights on this, and it’s such an important topic for all the young women who are diagnosed. Thank you. 

Dr. Matteo Lambertini: Thank you very much. It was my pleasure.

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