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#Grand Rounds

Is Pregnancy After Breast Cancer Safe for Women with BRCA Mutations?

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BACKGROUND AND PURPOSE:

  • Pregnancy after breast cancer appears to be safe and is not associated with an increased risk of cancer recurrence
    • However, data are limited regarding pathogenic BRCA variants
  • Lambertini et al. (Journal of Clinical Oncology, 2020) investigated the impact of pregnancy on breast cancer outcomes in patients with germline BRCA mutations

METHODS:

  • Multicenter, retrospective cohort study (January 2000 and December 2012
  • Participants
    • Breast cancer diagnosis  ≤ 40 years
    • Deleterious germline BRCA mutations
  • Exposures
    • Pregnancy after breast cancer
    • No pregnancy
  • Study design
    • Survival analyses | Adjusted for known prognostic factors including adjusted for age at diagnosis, tumor size, nodal status, hormone receptor status, type of endocrine therapy, breast surgery, and BRCA mutation
  • Primary outcomes
    • Pregnancy rate
    • Disease-free survival (DFS)
  • Secondary outcomes
    • Pregnancy outcomes
    • Overall survival (OS)

RESULTS:

  • 1252 patients were included
    • BRCA1: 811 patients
    • BRCA2: 430 patients
    • BRCA1/2: 11 patients
  • Median age at time of pregnancy: 35.7 years | Median time from diagnosis to pregnancy 4.5 years
  • 195 women had at least 1 pregnancy after breast cancer
  • Pregnancy outcomes
    • Pregnancy rate at 10 years: 19% (95% CI, 17% to 22%)
    • Induced abortions: 8.2%
    • Miscarriages: 10.3%
    • Births: 76.9% of women | 9.2% preterm
    • Adverse outcomes
      • Pregnancy complications: 11.6%
      • Congenital anomalies: 1.8%
  • Median follow-up from breast cancer diagnosis was 8.3 years
  • No differences in survival detected between the pregnancy and nonpregnancy groups
    • Disease free survival
      • Adjusted hazard ratio (HR) 0.87 (95% CI, 0.61 to 1.23)
      • P = 0.41
    • Overall survival
      • Adjusted HR 0.88 (95% CI, 0.50 to 1.56)
      • P = 0.66

CONCLUSION:

  • Pregnancy after breast cancer in patients with BRCA mutations is not associated with unfavorable survival outcomes or pregnancy outcomes
  • For women with BRCA mutations, pregnancy after breast cancer is safe and does not worsen prognosis
  • The authors conclude that

These findings are of paramount importance for health care providers involved in counseling young patients with BRCA-mutated breast cancer who inquire about the feasibility and safety of future conception

Learn More – Primary Sources:


Pregnancy After Breast Cancer in Patients With Germline BRCA Mutations

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Related ObG Topics:

Does Pregnancy Increase Risk of Breast Cancer?
BRCA1 & BRCA2 Mutations: What Are the Risks for Developing Breast and Ovarian Cancer?
For Women with A Personal History of Breast Cancer: Mammography or Breast MRI?

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