Association of the Timing of Pregnancy With Survival in Women With Breast Cancer

Iqbal, Javaid; Amir, Eitan; Rochon, Paula A.; Giannakeas, Vasily; Sun, Ping; Narod, Steven A.

doi:10.1001/jamaoncol.2017.0248

Cited by 84 publications

(74 citation statements)

References 41 publications

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“…Our results indicated that pregnancy after breast cancer treatment was not related to a poor survival outcome, both before and after propensity score matching. This result was consistent with the results of previous studies [8,17,29,30].…”

Section: Discussionsupporting

confidence: 94%

“…Furthermore, the high serum levels of pregnancy-related hormones are known to act as growth factors that affect breast cancer. A large population-based study and a metaanalysis found no difference, however, in recurrence or survival between breast cancer survivors who became pregnant and those who did not become pregnant after breast cancer treatment [8,17,29,30]. Recently, a population-based, retrospective cohort study using health administrative databases in Canada was reported [30].…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Pregnancy after Breast Cancer in Korean Women: A Large Cohort Study

et al. 2020

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Purpose The purpose of this study was to determine the rate and outcomes of pregnancies subsequent to breast cancer in Korea, and the effect of such pregnancies on the prognosis of women who survived breast cancer and subsequently conceived. Materials and Methods We followed a total of 31,761 Korean women 45 years of age or younger who were treated for primary breast cancer from 2002 to 2010. We also included follow-up surveys that were conducted through December 2011. We identified recurrence and mortality from breast cancer using data linked to the Korea National Health Insurance database. We used propensity score matching of the study cohort to analyze the risks of recurrence and mortality from breast cancer depending on pregnancy. Results Within our sample, 992 women (3.1%) became pregnant after receiving treatment for breast cancer. Of those, 622 (67.5%) successfully delivered; the remaining 370 (32.5%) failed to deliver. After propensity score matching, we found that the women who became pregnant after breast cancer did not have a different risk of recurrence (hazard ratio [HR], 0.503; 95% confidence interval [CI], 0.434 to 0.584) and death (HR, 0.520; 95% CI, 0.397 to 0.681), compared with those who did not conceive after breast cancer treatment. Conclusion Our study is the first to report outcomes for Korean women who survived breast cancer and subsequently conceived. Women who survived breast cancer and subsequently became pregnant did not show a poorer survival outcome, compared with those who did not become pregnant.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Outcomes of Pregnancy after Breast Cancer in Korean Women: A Large Cohort Study

et al. 2020

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“…Stimulation protocols that add letrozole or tamoxifen have been successfully implemented and keep serum estradiol close to physiologic levels during the cycle [43,46,47]. Live birth after breast cancer, even in endocrine sensitive tumors, is currently considered safe [48][49][50][51]. In our study, fifteen women had recurrent disease, five of them within 2 years after diagnosis.…”

Section: Discussionmentioning

confidence: 91%

Preserving fertility in young women undergoing chemotherapy for early breast cancer; the Maastricht experience

Vriens

Welle-Butalid

Boer

et al. 2020

Breast Cancer Res Treat

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Purpose We assessed the uptake of fertility preservation (FP), recovery of ovarian function (OFR) after chemotherapy, live birth after breast cancer, and breast cancer outcomes in women with early-stage breast cancer. Methods Women aged below 41 years and referred to our center for FP counseling between 2008 and 2015 were included. Data on patient and tumor characteristics, ovarian function, cryopreservation (embryo/oocyte) and transfer, live birth, and disease-free survival were collected. Kaplan-Meier analyses were performed for time-to-event analyses including competing risk analyses, and patients with versus without FP were compared using the logrank test. Results Of 118 counseled women with a median age of 31 years (range 19-40), 34 (29%) chose FP. Women who chose FP had less often children, more often a male partner and more often favorable tumor characteristics. The 5-year OFR rate was 92% for the total group of counseled patients. In total, 26 women gave birth. The 5-year live birth rate was 27% for the total group of counseled patients. Only three women applied for transfer of their cryopreserved embryo(s), in two combined with preimplantation genetic diagnosis (PGD) because of BRCA1-mutation carrier ship. The 5-year disease-free survival rate was 91% versus 88%, for patients with versus without FP (P = 0.42). Conclusions Remarkably, most women achieved OFR, probably related to the young age at diagnosis. Most pregnancies occurred spontaneously, two of three women applied for embryo transfer because of the opportunity to apply for PGD.

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“…However, recent studies have shown that there is no difference in prognosis between breast cancer during pregnancy and non-PABC; in cases of breast cancer during the postpartum period, the prognosis was poor [7, 26]. Recent data suggest that breast cancer diagnosed in the postpartum period has a worse prognosis than nulliparous women, and the risk of breast cancer increases by 5 years after delivery [27, 28], with a 2.8-fold higher rate of distant metastasis and a 2.65-fold higher mortality rate than those diagnosed up to 5 years after delivery [29]. In this database, breast cancer was compared with women of childbearing age because of limited data.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Prognosis of Pregnancy-Associated Breast Cancer: Poor Survival of Luminal B Subtype

Bae

Jung

et al. 2018

Oncology

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Background: Pregnancy-associated breast cancer (PABC) is rare and is generally defined as breast cancer diagnosed during pregnancy or within 1 year of delivery. The average ages of marriage and childbearing are increasing, and PABC is expected to also increase. This study is intended to increase understanding of the characteristics of PABC. Methods: A database of 2,810 patients with breast cancer diagnosed when they were less than 40 years of age was reviewed. The clinicopathological factors and survival of PABC (40 patients) were compared to those of patients with young breast cancer (YBC, non-pregnant or over 12 months after delivery; 2,770 patients). Results: PABC had significantly lower estrogen receptor (ER) and progesterone receptor (PR) expression (ER-positive 50.0%, PR-positive 45.0%) and higher HER2 overexpression (38.5%) than YBC. The most common subtype of PABC was triple-negative breast cancer (TNBC; 35.9%), and luminal A subtype represented only 7.7% of cases. In univariate analysis, PABC had significantly worse disease-free survival (DFS) and breast cancer-specific survival (BCSS) compared to YBC. In multivariate analysis, PABC was associated with worse BCSS (HR 4.0, 95% CI 1.2–12.9, p = 0.019) and survival, but there was no difference in DFS between PABC and YBC. In subgroup analysis by subtype, luminal B subtype of PABC showed worse DFS (HR 3.5; 95% CI 1.1–11.2, p = 0.039) and BCSS (HR 10.2, 95% CI 1.2–87.1, p = 0.035), especially with high Ki67. However, no differences were demonstrated in other subtypes. Conclusion: In this study, PABC showed lower expression of ER/PR, higher overexpression of HER2, fewer luminal A subtype, and more TNBC subtype compared to YBC. PABC had worse BCSS, especially luminal B subtype, compared to YBC.

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Association of the Timing of Pregnancy With Survival in Women With Breast Cancer

Abstract: Pregnancy did not adversely affect survival in women with breast cancer. For breast cancer survivors who wish to conceive, the risk of death is lowest if pregnancy occurs 6 months or more after diagnosis.

Cited by 84 publications

References 41 publications

Outcomes of Pregnancy after Breast Cancer in Korean Women: A Large Cohort Study

Outcomes of Pregnancy after Breast Cancer in Korean Women: A Large Cohort Study

Preserving fertility in young women undergoing chemotherapy for early breast cancer; the Maastricht experience

Clinical Characteristics and Prognosis of Pregnancy-Associated Breast Cancer: Poor Survival of Luminal B Subtype

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