Fertility Considerations for Reproductive-Aged Carriers of Deleterious<i>BRCA</i>Mutations: A Call for Early Intervention

Fine, Eliana; Knoll, Miriam A.; Maslow, Bat-Sheva L.

doi:10.1200/op.21.00389

Cited by 5 publications

(3 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Significant knowledge gaps and misconceptions exist among physicians in their oncofertility counseling. 4 Young breast cancer survivors have reduced chances of future conception compared with the general population and young survivors of most other malignancies. 7 Current guidelines recommend close monitoring of posttreatment pregnancies in adult women with a history of cancer due to a higher risk of pregnancy complications, including preterm births, in cancer survivors compared with the general population.…”

Section: Discussionmentioning

confidence: 99%

“…Women who are BRCA carriers face unique reproductive concerns. Significant knowledge gaps and misconceptions exist among physicians in their oncofertility counseling . Young breast cancer survivors have reduced chances of future conception compared with the general population and young survivors of most other malignancies .…”

Section: Discussionmentioning

confidence: 99%

“…1,2 More than 12% of these young patients carry a germline pathogenic variant in the BRCA1 or BRCA2 genes. 3 Reproductive counseling of BRCA carriers is particularly complex considering the psychological fear of transmitting the pathogenic variant to their offspring, 4 the possible negative impact of deficient BRCA function on their ovarian reserve and fertility potential, 5 and the indication to undergo risk-reducing bilateral salpingooophorectomy at a young age due to increased risk of ovarian cancer. 6 Moreover, while several studies have demonstrated the safety of conceiving following treatment completion for breast cancer, the evidence for BRCA carriers is very limited.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Pregnancy After Breast Cancer in Young BRCA Carriers

Lambertini,

Blondeaux,

Agostinetto

et al. 2024

JAMA

View full text Add to dashboard Cite

ImportanceYoung women with breast cancer who have germline pathogenic variants in BRCA1 or BRCA2 face unique challenges regarding fertility. Previous studies demonstrating the feasibility and safety of pregnancy in breast cancer survivors included limited data regarding BRCA carriers.ObjectiveTo investigate cumulative incidence of pregnancy and disease-free survival in young women who are BRCA carriers.Design, Setting, and ParticipantsInternational, multicenter, hospital-based, retrospective cohort study conducted at 78 participating centers worldwide. The study included female participants diagnosed with invasive breast cancer at age 40 years or younger between January 2000 and December 2020 carrying germline pathogenic variants in BRCA1 and/or BRCA2. Last delivery was October 7, 2022; last follow-up was February 20, 2023.ExposurePregnancy after breast cancer.Main Outcomes and MeasuresPrimary end points were cumulative incidence of pregnancy after breast cancer and disease-free survival. Secondary end points were breast cancer–specific survival, overall survival, pregnancy, and fetal and obstetric outcomes.ResultsOf 4732 BRCA carriers included, 659 had at least 1 pregnancy after breast cancer and 4073 did not. Median age at diagnosis in the overall cohort was 35 years (IQR, 31-38 years). Cumulative incidence of pregnancy at 10 years was 22% (95% CI, 21%-24%), with a median time from breast cancer diagnosis to conception of 3.5 years (IQR, 2.2-5.3 years). Among the 659 patients who had a pregnancy, 45 (6.9%) and 63 (9.7%) had an induced abortion or a miscarriage, respectively. Of the 517 patients (79.7%) with a completed pregnancy, 406 (91.0%) delivered at term (≥37 weeks) and 54 (10.4%) had twins. Among the 470 infants born with known information on pregnancy complications, 4 (0.9%) had documented congenital anomalies. Median follow-up was 7.8 years (IQR, 4.5-12.6 years). No significant difference in disease-free survival was observed between patients with or without a pregnancy after breast cancer (adjusted hazard ratio, 0.99; 95% CI, 0.81-1.20). Patients who had a pregnancy had significantly better breast cancer–specific survival and overall survival.Conclusions and RelevanceIn this global study, 1 in 5 young BRCA carriers conceived within 10 years after breast cancer diagnosis. Pregnancy following breast cancer in BRCA carriers was not associated with decreased disease-free survival.Trial RegistrationClinicalTrials.gov Identifier: NCT03673306

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%