Women who have been treated for breast cancer are less likely than the average woman to get pregnant and have a higher risk of certain complications, such as preterm labor. However, research shows that most of these women deliver healthy babies and childbirth has no effect on their long-term survival.
The research was presented on Dec. 10, 2020, at the 2020 San Antonio Breast Cancer Symposium. Read the abstract of “Chances of pregnancy after breast cancer, reproductive and disease outcomes: A systematic review and meta-analysis.”
Fertility and pregnancy after breast cancer
Many women diagnosed with breast cancer, especially younger women, are concerned about their ability to have children after treatment. Some breast cancer treatments can cause temporary infertility or make it harder to get pregnant after treatment ends. Other treatments, especially certain chemotherapy regimens, can cause early menopause and infertility.
If having children is important to you, one of the most critical things you can do as you're planning your breast cancer treatment is talk to your doctor about your fertility options. Research shows that doctors often don't provide enough information about what can happen to fertility with different breast cancer treatments, and most doctors don't direct patients to fertility specialists for counseling before treatment begins. This could happen, in part, because many doctors have concerns about the safety of pregnancy after breast cancer treatment. So if your doctor doesn't start the conversation, it's important to speak up about your concerns.
“Pregnancy-related issues are of high importance for our young breast cancer patients,” explained study author Matteo Lambertini, M.D., Ph.D., of the University of Genoa and Policlinico San Martino Hospital in Italy. “There are still a lot of misconceptions among physicians about the safety of pregnancy after breast cancer that we are trying to dispel with our research that supports the safety of these pregnancies.”
About the study
This study was a meta-analysis. A meta-analysis combines and analyzes the results of many earlier studies. In this case, the researchers analyzed the results of 39 studies looking at pregnancy after breast cancer. The studies included:
- more than 8 million women from the general population
- more than 57,700 women diagnosed with cancers other than breast cancer
- more than 114,500 women diagnosed with breast cancer
The researchers looked at:
- chances of pregnancy after breast cancer
- outcomes for mothers and babies
- disease-free survival
- overall survival
Disease-free survival is how long a person lives without the breast cancer coming back (recurrence). Overall survival is how long a person lives, whether or not the breast cancer comes back.
Compared to women from the general population, women who had been treated for breast cancer:
- were 60% less likely to get pregnant
- were more likely to have a low birth-weight baby
- were more likely to have a baby that is small for its gestational age
- were more likely to give birth early
- were more likely to have a caesarean section
Compared to women from the general population, women who had been treated for breast cancer did not have a higher risk of:
- congenital deformities
- bleeding before or after giving birth
- any other pregnancy or delivery complications
Lambertini pointed out that the results showing that women who had been diagnosed with breast cancer were 60% less likely to get pregnant could be somewhat misleading.
“What we do not know from these studies is how many women actually tried to get pregnant,” he explained. “There may have been some women who did not want to become pregnant. That is a very important point to address.”
The researchers also found that being treated with chemotherapy did not increase the risk of pregnancy complications, nor did getting pregnant less than 2 years after being diagnosed with breast cancer.
Pregnancy after breast cancer did not affect the mothers’ disease-free survival or overall survival.
“The main message from this analysis is that babies are safe,” Lambertini said. “But we have to monitor more closely these pregnancies.”
What this means for you
If you’ve been diagnosed with breast cancer and are concerned about preserving your fertility, it makes sense to talk to your doctor about your fertility options before you start treatment. If your doctor doesn’t bring up the subject, be your own best advocate and start the discussion.
If chemotherapy is recommended for you, it may be possible for you to be treated with medicine to temporarily shut down your ovaries while you’re being treated. Research has shown that ovarian shut down during chemotherapy can increase the chances of having a child after treatment.
There also are other options available, including harvesting mature eggs from your ovaries before treatment starts. The most important thing to do is to talk to your doctor about fertility as you’re planning your treatment. You also can ask for a referral to a fertility specialist for counseling before treatment begins.
For more information, visit the Breastcancer.org pages on Fertility and Pregnancy Issues During and After Breast Cancer.
To discuss this study with others or talk about your fertility options, join the Breastcancer.org Discussion Board forum Family and Family Planning Matters.
Written by: Jamie DePolo, senior editor
Reviewed by: Brian Wojciechowski, M.D., medical adviser
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