Fertility Treatments Safe for Survivors With BRCA Mutations
The use of assisted reproductive technologies (ART) does not appear to increase pregnancy complications or risks of cancer coming back in young women with a BRCA1 or BRCA2 mutation and a history of breast cancer. These findings were presented in May at the ESMO Breast Cancer conference.
Key takeaways
Among more than 540 women with a BRCA mutation who were age 40 or younger when diagnosed with early-stage breast cancer and who became pregnant, 80% conceived naturally and 20% used ART.
The main types of ART used were egg or embryo freezing at the time of breast cancer diagnosis, ovarian stimulation after breast cancer treatment, and embryo transfer after a donated egg was fertilized.
There were no differences in pregnancy complications between women who used ART and women who conceived naturally.
There was no significant difference in survival between women who used ART and those who did not nine years later.
What the results mean for you
The take-home message from this study is very reassuring: “[P]ursuing fertility preservation before undergoing breast cancer treatment or using the products of fertility preservation (eggs or embryos) or undergoing fertility preservation after surviving breast cancer all appear to be safe from a cancer standpoint and in terms of the baby’s outcome,” Ann Partridge, MD, MPH, professor of medicine at Harvard Medical School and vice-chair of medical oncology at Dana-Farber Cancer Institute and Brigham and Women’s Hospital, said in a statement. Dr. Partridge is a co-author of the study and is the leader of The Young Women’s Breast Cancer Study, which contributed data to the study on ART.
These results echo findings from an analysis of the POSITIVE trial presented at the 2023 San Antonio Breast Cancer Symposium showing that younger women diagnosed with hormone receptor-positive breast cancer who paused hormonal therapy to try to become pregnant could safely use ART without increasing the risk of recurrence.
Listen to the episode of The Breastcancer.org Podcast featuring Dr. Hatem Azim discussing this analysis.
ART Doesn’t Increase Hormone Receptor-Positive Breast Cancer Recurrence Risk
Dec 7, 2023About the study
Surveys of young women diagnosed with breast cancer show that more than half are very concerned about fertility issues and about a third said that fertility concerns influenced their treatment decisions.
“We have previously been concerned that increasing hormone levels for fertility preservation techniques before starting breast cancer treatment may increase the risk of cancer recurrence in the future,” Matteo Lambertini, associate professor and consultant in medical oncology at the University of Genova, who presented the research, said in a statement. “There has been even more concern in women with pathogenic variants in the BRCA genes because of their increased risk of breast cancer and other cancers. And so strategies to preserve fertility were often not even discussed with these patients. This was the main rationale for our study: to provide the evidence on whether fertility treatments are safe in patients with breast cancer and, specifically in those with pathogenic variants in the BRCA genes.”
Detailed results
The researchers looked at the records of 4,732 women with a BRCA1 or BRCA2 mutation who had been diagnosed with stage I to stage III breast cancer at age 40 or younger between January 2000 and December 2020. The women were treated at 78 centers around the world.
The study focused on information from 543 women who became pregnant after breast cancer:
436 conceived naturally
107 used ART
Of the women who used ART:
42.1% had their eggs or embryos frozen when they were diagnosed
30.8% received medicine to stimulate their ovaries to produce more eggs available for fertilization after breast cancer treatment
19.6% had an embryo implanted after a donated egg was fertilized
Overall, 83% of women who used ART and 79.8% of women who didn’t use ART delivered a child.
Using ART didn’t affect recurrence rates:
12.1% of women who used ART had a recurrence
27.1% of women who didn’t use ART had a recurrence
While more women who didn’t use ART had a recurrence, the difference in recurrence rates between the two groups wasn’t statistically significant, which means it could be due to chance and not because of the difference in ART use.
Compared to women who conceived without using ART, women who used ART:
were older at the time of conception (37 years versus 34 years)
were more likely to have been diagnosed with hormone receptor-positive breast cancer (43.4% versus 30.8%)
had a longer median time from diagnosis to conception (4.2 years versus 3.3 years)
had slightly more miscarriages and fewer abortions that women who didn’t use ART
Lambertini, M. et al. Safety of assisted reproductive techniques in young BRCA carriers with a pregnancy after breast cancer: Results from an international cohort study. ESMO Breast Cancer 2024, Abstract 266O.
— Last updated on August 31, 2024 at 1:11 PM