Pregnancy after Breast Cancer
I remember when young women who had been through breast cancer were strongly advised never to consider a pregnancy. The worry was that all the changes and intense hormones normal to pregnancy would fertilize and invigorate any remaining cancer cells. This directive was very distressing to many women who already were dealing with issues well beyond the norm for their peer group.
I have long been aware that losing the possibility of bearing a child can also be very painful for women who really had not been planning to do so. Whether these are women who already have a family or women who were childless, the dream is powerful, and it is painful to lose the choice. One reality of breast cancer treatment is that the chemotherapy and hormonal therapy may stop menses, either temporarily in young women or permanently in slightly older women (usually around 40 or older). Even women whose periods do return likely have lost several years of possibilities due to treatment--especially if they are taking Tamoxifen for five years. In any circumstances, fertility declines with age, so this is an additional problem.
Over the past decade or so, physicians have changed their views about the safety of pregnancy. Most doctors still advise their patients to wait a year or so after completion of therapy (both to give their bodies time to fully recover and to guard against the rare but devastating cancer that returns almost immediately), but the prevailing research and view is that pregnancy does not increase the possibility of recurrence. I know a number of women who have gone on after cancer to have healthy pregnancies and healthy babies.
This is an article from The European Journal of Cancer that reviews the relevant research. I am including an excerpt and then a link to read it all:
ticle in Press
Safety of pregnancy following breast cancer diagnosis: A metaanalysis
of 14 studies
Hatem A. Azim Jr., Luigi Santoro, Nicholas Pavlidis, Shari Gelber, Niels Kroman, Hamdy Azim, Fedro A. Peccatori
Received 22 July 2010; received in revised form 28 August 2010; accepted 2 September 2010. published online 14 October 2010.
Due to the rising trend of delaying pregnancy to later in life, more women are diagnosed with breast cancer before completing their families. Therefore, enquiry into the feasibility and safety of pregnancy following breast cancer diagnosis is on the rise.
Available evidence suggests that women with a history of breast cancer are frequently advised against future conception for fear that pregnancy could adversely affect their breast cancer outcome. Hence, we conducted a meta-analysis to understand the effect of pregnancy on overall survival of women with a history of breast cancer.
Two of the authors independently performed a literature search up to September 2009 with no language restrictions. Eligible studies were published retrospective control-matched, population-based and hospital-based studies that have addressed the impact of pregnancy on the overall survival of women with history of breast cancer. Pooling of data was done using the random effect model. Unpublished statistics from three studies were obtained to perform further subgroup and sensitivity analyses. This included examining the effect of pregnancy according to age at diagnosis, healthy mother effect, type of study, nodal status and other parameters.
Fourteen studies were included in this meta-analysis (1244 cases and 18,145 controls). Women who got pregnant following breast cancer diagnosis had a 41% reduced risk of death compared to women who did not get pregnant [PRR: 0.59 (90% confidence interval (CI): 0.50-0.70)]. This difference was seen irrespective of the type of the study and particularly in women with history of node-negative disease. In a subgroup analysis, we compared the outcome of women with history of breast cancer who became pregnant to breast cancer patients who did not get pregnant and were known to be free of relapse. In this analysis, we did not find significant differences in survival between either group [PRR: 0.85; 95% CI: 0.53-1.35].
This study confirms that pregnancy in women with history of breast cancer is safe and does not compromise their overall survival. Hence, breast cancer survivors should not be denied the opportunity of future conception.