Pregnancy after Breast Cancer

One of the dilemmas facing young women treated for breast cancer is the issue of pregnancy. Is it safe for a breast cancer survivor to become pregnant? To deliver at term? Given the hormone surge associated with pregnancy, do women place themselves at a bigger risk of relapse and ultimately, of death? It has been so controversial that as recently as four years ago I saw a 28 year-old breast cancer survivor in consultation after her personal medical oncologist had recommended termination of the pregnancy on fears it would lead to a relapse.

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For these women interested in living, and in being a mother, there is reason to think these concerns are unjustified. At the European Breast Cancer Conference, Azim and colleagues presented their findings on the safety of pregnancy after breast cancer. To do this they reviewed all the relevant literature and compiled data in to a large analysis (called a meta-analysis). Their review included 14 trials, with over 19,000 women included (1417 of whom had achieved pregnancy).

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Their results: patients who achieved pregnancy after breast cancer were 42% more likely to survive than those who did not (Hazard ratio, 0.58, Confidence interval, 0.49-0.68). This was a highly significant result. This supports a concept in the field of cancer called the "healthy mother" effect, first championed by Sankila, et al. in 1994. This phenomenon rests on the idea that women who feel healthy will get pregnant and give birth; those who are impacted by the diagnosis will not. Thus, pregnancy in and of itself is felt not to be a harbinger of bad outcomes, but rather identifies a group of women likely to do well.

This should be good news to those interested in having children after breast cancer. The risks of pregnancy appear non-existant, provided that women complete primary therapy for their index breast cancer. Providers should take notice and hopefully, women will not have to face the decision of terminating a pregnancy or surviving breast cancer. One can indeed become a mother and beat breast cancer!

References:

1) Azim HA, et al. Safety of pregnancy in breast cancer survivors: a meta-analysis. European Journal of Cancer Supplements 2010; 8:207.

2) Sankila R, et al. Survival of breast cancer patients after subsequent term pregnancy: "healthy mother effect". American Journal of Obstetrics and Gynecology 1984; 170:818-23.