January 5, 2023 – Planning to have a toddler is a life-changing decision. For women who've survived breast cancer, the consideration is much more complex.
For a protracted time, there was no clear research on how pregnancy affects the likelihood of cancer returning. But early results from a brand new study show that girls who interrupted protective therapies after cancer to develop into pregnant didn't have an increased risk of cancer returning. Almost three out of 4 women within the study became pregnant and 64% had a live birth.
One of those “breast cancer babies” was Ronin Andrade, who turns one on January 6. His mother, Shayla Johnson of Assonet, MA, plans to bake him an Instagram-worthy cake. She participated within the research study.
“As a woman, I felt like I had lost my breasts, my hair, my figure, and the inability to have a child would have been overwhelming. But that wasn't the case, and 10 pounds later, I have a child,” said Johnson, 40, who was diagnosed with the disease at age 34 and likewise carries a dangerous genetic mutation called BRCA2 that's linked to breast cancer.
One of essentially the most effective treatments for stopping breast cancer from recurring is named “endocrine therapy.” This involves taking certain drugs to stop the return of cancer cells that feed on hormones comparable to estrogen or progesterone. The beneficial duration of endocrine therapy is 5 to 10 years.
The study Johnson participated in, called the POSITIVE trial, followed 518 women ages 42 or younger who stopped taking hormone therapy for about 2 years while they tried to get pregnant. The study included women with early-stage breast cancer (as much as stage III) that had not spread beyond the breast or nearby lymph nodes. The women accomplished hormone therapy for at the very least 18 months before stopping therapy to attempt to get pregnant.
Among the study participants, the breast cancer reoccurrence rate was 8.9% inside a median follow-up period of about 3.5 years. This rate was much like the common reoccurrence rate of 9% inside 3 years present in previous studies. The recent POSITIVE study Results were presented on the San Antonio Breast Cancer Symposium in December.
“These data from the POSITIVE trial apply to women with hormone-sensitive early-stage breast cancer who want to become pregnant and want to interrupt hormone therapy to become pregnant,” says lead researcher Ann Partridge, MD, MPH, associate director of medical oncology at Dana-Farber Cancer Institute. “It does not appear that pregnancy…or interrupting hormone therapy confers a worse prognosis.”
Is pregnancy less likely after breast cancer?
Most breast cancer cases occur in middle-aged women or older, but annually 5% of girls aged 40 and under are diagnosed with the disease. The recent research is significant because young women are increasingly not having children until their 30s. The risk of breast cancer increases with age, so more women will develop the disease before they've children or complete family planning.
“Another important point is that as you get older, it becomes more difficult to get pregnant,” says Partridge.
For example, a girl could also be diagnosed in her early 30s, undergo a 12 months of lively treatment comparable to mastectomy, chemotherapy and radiation, after which be prescribed five to 10 years of endocrine therapy, essentially taking over most of her remaining reproductive years.
In addition to examining the protection of interrupting endocrine therapy, the outcomes of the POSITIVE trial provided insight into a vital recent area of evaluation that concerns many breast cancer survivors: the likelihood of pregnancy.
Previous research shows that chemotherapy can negatively affect fertility, while endocrine therapy is taken into account secure. However, women mustn't take it in the event that they wish to develop into pregnant, says oncologist Matteo Lambertini MD, PhD of the University of Genoa in Italy, who's an authority in pregnancy after breast cancer.
“Half of newly diagnosed women say they are concerned about their fertility,” says Lambertini.
Researchers said pregnancy and birth rates amongst participants within the POSITIVE study were equal to or higher than those in the final population.
Of the 74% of participants who became pregnant, 86% had a live birth. Some women stopped hormone therapy for longer than the beneficial 2 years, in response to data published on the symposiumAmong the participants, 75% had never given birth, 94% had stage I or II breast cancer, and 62% were receiving chemotherapy.
According to Partridge, 43 percent of girls within the study used some type of assisted reproductive technology (ART), comparable to in vitro fertilization (IVF). However, researchers haven't yet analyzed what quantity of pregnancies were as a result of ART.
“Sometimes people use ART not because they are infertile, but because they want to avoid a BRCA mutation or use embryos to get pregnant faster,” says Partridge. “Particularly for BRCA mutation carriers, they may want to implant an embryo that does not have the mutation… We need to look at this data much more closely. There are a lot of nuances.”
Partridge and Lambertini indicate that longer follow-up of study participants is required to completely understand any long-term risks of pregnancy or interruption of endocrine therapy.
Fertility within the foreground
Caitlin Baltera, 34, of Colorado Springs, CO, has been on hiatus from hormone therapy for 2 years while attempting to conceive.
“It's definitely hard when you hear you have two years left,” says Baltera, who was diagnosed with stage I breast cancer at age 30. “Of course, when you're trying to get pregnant, everyone tells you, 'Take it easy. Don't worry.' And I say, 'I only have two years left.'”
“Most people don’t have a threshold at which they might put themselves in danger if they keep trying,” she says.
Baltera, who began a brand new relationship on the time of her diagnosis and is now married, has spent nearly $30,000 on fertility treatments, a few of it on prepaid IVF cycles. She says her insurance did a superb job of covering the associated fee of her cancer treatments, which included chemotherapy, which is thought to affect fertility.
Some breast cancer survivors at the moment are calling for changes in how fertility coverage is handled, much like an earlier movement that focused on breast reconstruction coverage. In the United States, most group insurance policy at the moment are required by law to cover breast reconstruction surgery.
“It often made me angry when I thought that reconstruction or whatever your option is is covered, whether it's fat grafting or implants, that's all covered. But with fertility, it's different,” says Baltera. “Many of us are medically infertile. And if you're proud to offer reconstruction, there's this other side effect that doesn't seem to be mentioned.”
Caragh Logan from London also believes that more focus must be placed on the impact of breast cancer on fertility. She was one in all many ladies within the Facebook group Babies After Breast Cancer who were eagerly awaiting the POSITIVE results of the study.
“So many young women get breast cancer every year and have to make really difficult decisions. We need direction, we need clarity,” says Logan, 37. “If they were men and the risk was men, I think they would have looked at these things sooner.”
Logan was diagnosed with breast cancer in 2017 and in 2020, she had a relapse that spread to her spine. However, after treatment, she showed no signs of the disease. She asked her oncologist if the POSITIVE results of the study would apply to her situation, as her cancer had progressed beyond the study parameters but then responded to treatment.
“My previous oncologist said he would like me to try tamoxifen after five years of taking it. [a hormone therapy for breast cancer] in October 2023 if I was willing to take the risk,” says Logan. “But he recently retired and the new oncologist is much more cautious.”
Her eggs were retrieved before her first treatment and she is going to consider surrogacy if she doesn't proceed attempting to conceive, but she says that's something she is going to evaluate once her five-year course of hormone therapy is complete.
Lambertini says breast cancer experts plan to formally discuss the difficulty of pregnancy in women with breast cancer more advanced than that studied within the POSITIVE trial next 12 months. Because treatments have develop into so successful, women with a stage IV (or metastatic) breast cancer diagnosis reside longer than ever before. One of Lambertini's stage IV patients has had an entire response to treatment for six years and needs to have a toddler.
“At the moment we can't say if it's safe because we don't have any data,” he says. “We may be able to cure patients with advanced disease. She's 39, so she's still completely on schedule for pregnancy. But it's a data-free zone. It's also very difficult for us to counsel our patients on this.”
In addition, the outcomes of a big international study examining the protection of pregnancy in women who carry the BRCA genetic mutation, which is related to an increased risk of cancer, are as a result of be published in autumn 2023, says Lambertini.