Pregnancy after Breast Cancer
Posted 4/1/2010
Posted in
I remember when women, after breast cancer, were strongly advised not to become pregnant. I remember the anguish this caused for young women who had already had to contend with a life-threatening illness at a time when their peers could live in age-appropriate blissful denial of mortality.
Over the years, I have seen this situation change and have known quite a few women who went on to have healthy pregnancies and healthy babies after breast cancer. Obviously, this is still a painful and difficult and complicated topic. There are issues around age and fertility (as women have delayed pregnancy to focus on their professional lives and have often married later, they may have been at the far end of their conceiving years when breast cancer happened), around prognosis, around relationships, around the choice. This study, however, is very reassuring re the physical impact of pregnancy as it suggests there is no negative impact of pregnancy on possible breast cancer recurrence.
This is long, but, because it is so important, I am including comments from BreastCancer.org as well as a summary of the study:
EBCC: Pregnancy No Hazard to Breast Cancer Survivors
2010-03-26T02:57:17-04:00
Charles Bankhead
What breastcancer.org says about this article…
EBCC: Pregnancy No Hazard to Breast Cancer Survivors
In the United States, there are about 400,000 breast cancer survivors younger than 45. Many of these women might want to have children. The analysis reviewed here found that pregnancy doesn't negatively affect the
future survival of women who've been diagnosed with breast cancer. These results were presented at the 2010 European Breast Cancer Symposium. Hormones can promote the growth and spread of breast cancer. Hormone levels change during pregnancy, so doctors have been concerned that becoming pregnant after a breast cancer diagnosis might increase the risk of the breast cancer coming back or affect future survival. Some doctors have recommended that women not get pregnant after being treated for early-stage breast cancer.
The analysis reviewed here is called a meta-analysis because it analyzes the results of several different studies. The researchers looked at the information from 14 studies comparing health outcomes, including survival, of between about 1,400 breast cancer survivors who did become pregnant to about 18,000 breast cancer survivors who didn't become pregnant.
Overall, breast cancer survivors who became pregnant had a 42% survival improvement compared to survivors who didn't become pregnant. Survival improvement ranged from 14% better to 79% better among the studies. Researchers aren't sure why the women who got pregnant had better survival compared to women who didn't get pregnant. It could be that the improved survival seen among the women who became pregnant was due to better overall health and not because of being pregnant. So the researchers didn't jump to the conclusion that pregnancy after breast cancer treatment improves survival. Instead, their conclusion was that pregnancy doesn't negatively affect future survival among survivors.
If you're being treated for breast cancer or are a survivor and think you might want to become pregnant in the future, this study suggests that you can do so and not negatively affect your future survival. Learn more about fertility issues and planning for children after breast cancer treatment in the Breastcancer.org Fertility, Pregnancy and Adoption section.
BARCELONA (MedPage Today) -- For women who've had breast cancer, getting pregnant does not adversely affect survival and might even improve it, data from meta-analysis suggest.
Patients who became pregnant after breast cancer diagnosis had a 42% improvement in survival compared with breast cancer patients who did not become pregnant, Hatem A. Azim, Jr., MD, of Jules Bordet Institute in Brussels, reported here at the European Breast Cancer Conference. But, although statistically significant, the risk reduction emerged from studies that appeared to have selection bias toward healthier patients. "Breast cancer patients who want to get pregnant can go ahead and get pregnant," Azim said during a press briefing. "There is no evidence that pregnancy has any adverse effect on survival."
Early detection and effective treatment of breast cancer has led to a growing population of survivors, many of them still of child-bearing age. An estimated 400,000 breast cancer survivors in the United States are younger than 45, Azim said. For many of those young women, pregnancy remains an issue with respect to its potential effects on continued breast cancer survival.
"Breast cancer is a hormonally driven tumor, and it is widely perceived that pregnancy in women with a history of breast cancer could have detrimental effects on breast cancer outcome by means of hormonal stimulation," Azim said. Young breast cancer survivors often are counseled against pregnancy, and studies have suggested high rates of elective abortion among survivors who become pregnant, he added. In an effort to clarify the risk that pregnancy poses to breast cancer survivors, Azim and colleagues reviewed the medical literature and identified 14 case-control studies that compared outcomes in breast cancer survivors who became pregnant and those who did not. The studies comprised 1,417 pregnancies, and a control group of 18,059 women who did not become pregnant.
The results showed that pregnancy after breast cancer diagnosis was associated with a hazard ratio for overall survival of 0.58, representing a 42% reduction in mortality risk compared with the control group (95 CI 0.49-0.68). All 14 studies resulted in hazard ratios that favored pregnancy for overall survival, ranging from 0.21 to 0.86. Eight of the studies yielded statistically significant differences in survival, as reflected in confidence intervals that did not include 1.00.
Although selection bias might explain some of the difference, some studies included in the analysis showed improved survival in analyses limited to control patients who did not have relapses during the study group's pregnancies. Despite pregnancy's significantly favorable impact on mortality risk, Azim said, "I would not promote the results of the study as being protective because you cannot ask the patient to get pregnant as an effective means for breast cancer treatment. The concept is that breast cancer patients who want to get pregnant could go ahead and get pregnant. There is no evidence that this has any adverse effect on survival."
The reasons for the favorable effect of pregnancy on survival are unclear, he added. However, speculation about possible adverse effects of pregnancy have often centered on hormonal or immune processes that create a more favorable microenvironment for tumor cell growth.
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