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Pregnancy after breast cancer treatment

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Around the world, there is a trend that women are increasingly coming to the need for later realization of childbearing function. Today in Russia, the average age of a woman at the birth of her first child is 28.5 years.

At the same time, there is an increase in the prevalence of breast cancer (BC) among young women (up to 45 years). According to data for 2019, they account for up to 24.0%. This means that almost a quarter of breast cancer patients are of reproductive age and some patients do not have children.

Patients with a history of breast cancer are less likely to be able to bear and give birth to a child. Therefore, the issue of maintaining fertility and pregnancy safety after breast cancer treatment is extremely relevant. Many studies are devoted to him.

A lot of knowledge has already been accumulated about the negative impact of breast cancer and the consequences of its treatment on a woman's reproductive health, as well as the course and outcome of pregnancy.

It is well known that treatment of breast cancer can lead to:

  • transient amenorrhea (menstrual function disorder);
  • premature menopause;
  • infertility.

Delivery of such patients is associated with higher risks:

  • premature birth;
  • postpartum bleeding;
  • delivery by emergency caesarean.

However, the outcomes are always individual and closely related to the age of the patient, the type of tumor, the type and amount of therapy needed. Pregnancy after radical treatment of breast cancer does not worsen the long-term results of therapy, and an increase in the risk of congenital fetal abnormalities or other complications in such patients is not observed.

Which ones recommendations will help to increase the safety of one of the most important periods in the life of a woman faced with breast cancer:

  • Pregnancies and subsequent births after breast cancer treatment do not worsen the prognosis of cancer, regardless of the receptor status of the tumor and the presence of BRCA1 gene mutations.
  • Termination of pregnancy is not justified and does not improve the prognosis of the disease.
  • The safe interval is before pregnancy after treatment from 2 years or more. The exact term must be discussed with the attending physician, since it is largely determined by the prevalence of the pathological process.
  • At the stage of pregnancy planning, it is necessary to conduct a complete examination of the patient, including consultation with a geneticist, genetic testing – mutations of the BRCA1 and TP53 genes (all patients diagnosed with breast cancer and/or ovaries under 45 years of age) and, in case of a positive result, discussion of preventive mastectomy.
  • All patients should be monitored in outpatient cancer care centers throughout pregnancy.
  • Young patients with an established diagnosis of breast cancer should be referred for consultation with reproductologists to discuss the issue of preserving genetic material, the possibility of using high-tech reproductive technologies before starting drug treatment (cryopreservation of oocytes, embryos, ovarian tissue).

 

 

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GBUZ Moscow Clinical Scientific Center named after Loginov MHD