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Pregnancy after breast cancer protected for BRCA gene carriers: study

January 19, 2024 – A brand new study within the Journal of the American Medical Association presents hopeful findings about pregnancies in young breast cancer survivors whose genes carry not only an increased risk of cancer but additionally the danger of fertility problems. Of the nearly 5,000 women within the study, 22% became pregnant, most of them naturally, and for many there was no evidence of an increased risk of breast cancer coming back after pregnancy.

Researchers have sought to raised assess the impact of pregnancy on breast cancer reoccurrence in BRCA gene mutation carriers because reproductive counseling for ladies might be complicated. The study authors found that many ladies are afraid of passing on BRCA gene mutations to their children. Women's genes may also affect reproductive aspects corresponding to ovarian reserve or the reproductive potential of their ovaries based on the amount and quality of their eggs. Many affected women proactively have their ovaries and fallopian tubes removed as a consequence of an increased risk of ovarian cancer, leaving only a narrow window of time between breast cancer treatment and preventive surgery until pregnancy.

Published last month, the Results showed an almost an identical risk of breast cancer reoccurrence in BRCA carriers who became pregnant in comparison with those that didn't. “It is the first large study to provide evidence of the safety of pregnancy in this group,” said lead writer Matteo Lambertini, MD, PhD, noting that the one other study was a “very, very small” one before about 10 years ago.

The latest evaluation included 4,732 women aged 40 or younger who had early-stage breast cancer and carried gene mutations called BRCA1 or BRCA2, which offer a high level of prediction that a lady will develop breast cancer. During about eight years of follow-up, researchers compared the breast cancer reoccurrence rate within the 659 women who became pregnant with that of the 4,073 women who didn't. The average age at diagnosis of breast cancer was 35 years.

About one in five women within the study became pregnant inside 10 years of diagnosis, although the pregnancy rate is probably not an accurate measure of the likelihood of pregnancy since the study doesn't know the way many tried. The women who became pregnant tended to be younger on the time of cancer diagnosis, and the typical age at delivery was almost 35 years. About one in five pregnancies involved assisted reproductive techniques corresponding to in vitro fertilization, while the opposite 4 in five pregnancies occurred without medical assistance.

Forty-five women who became pregnant had an abortion and 63 had a miscarriage. The remaining 517 children delivered at 37 weeks or later, and about 10% of the finished pregnancies were twins. The evaluation found that the ladies had no increased risk of pregnancy complications, nor was there an increased risk of poor outcomes for the babies.

Nine out of 10 women within the study received chemotherapy as a part of their cancer treatment, notable for its link to infertility.

“Patients who had a pregnancy had significantly better breast cancer-specific survival and overall survival,” the authors write.

“Most of the time, patients who become pregnant tend to have better outcomes,” said Lambertini, an associate professor of oncology on the University of Genoa in Italy. “I don’t want to give the message that pregnancy is protective, but I am saying that pregnancy certainly doesn’t increase the risk of relapse.”

Lambertini said the important message from this study's results needs to be concerning the safety of pregnancy because “there are many oncologists in the clinic who still advise their patients not to have a pregnancy because they fear there may be an increased risk of recurrence.” So an important message is that pregnancy doesn't increase the danger of reoccurrence.”

“Potentially, as we discussed in the paper, it could be that the patients with a better prognosis become pregnant later and the patients with a worse prognosis may be the patients who relapse the first time.” A number of years after that diagnosis, they may never give you the chance to get pregnant,” Lambertini said.

Other possibilities for the improved survival data could include details related to the sort of cancer the pregnant women had, or perhaps related to the ladies's immune systems.

“We know that there are a lot of changes in the immune system during pregnancy,” Lambertini said.

The BRCA gene mutations are related to a significantly higher risk of developing breast cancer, especially in each breasts. Approximately 13% of girls in the final population will develop breast cancer sooner or later of their lives, but studies show that greater than half of BRCA1 carriers and no less than 45% of BRCA2 carriers will develop breast cancer National Cancer Institute. The mutations also carry an increased risk of ovarian cancer and are linked to cancers that occur at younger ages.

About half of the ladies within the study received a risk-reducing salpingo-oophorectomy, through which the ovaries and fallopian tubes are removed. 43% of pregnant women ultimately underwent the procedure; Of those without pregnancy, 53 had the procedure.

The authors noted that the evaluation revealed some differences in risks depending on whether a lady had the BRCA1 or BRCA2 gene mutation, which could also be related to specific points of the sort of breast cancer a lady has. The BRCA2 carriers tended to have the next reoccurrence rate and were also more more likely to have cancers that were sensitive to hormones corresponding to estrogen. But when researchers checked out all the ladies within the study who had hormone-sensitive cancer, there was no overall increased risk of reoccurrence, ultimately suggesting that reproductive counseling for BRCA carriers needs to be individualized based on the small print of the everybody's specific cancer diagnosis.

“Overall, I would say that this study shows that pregnancy is safe, but in patients with a BRCA2 mutation, I would be a little more cautious,” Lambertini said, noting that he has his own BRCA2 patients who If you might have hormone-sensitive cancer, you would possibly first be advised to undergo special hormone therapy for five years to scale back the danger of reoccurrence, corresponding to: B. by taking the drug tamoxifen before deciding to develop into pregnant.