Powerful new data about pregnancy outcomes among women who have survived breast cancer support the choice many of them take of going ahead with a pregnancy despite facing breast cancer treatment and uncertainties about their future health. A very large population-based cohort study, discussed at the European Society for Medical Oncology (ESMO) Breast Cancer 2022 Congress, found that obstetric outcomes were acceptable and that women wanting to have a baby could go ahead and do so (Abstract 214P).
"If a patient wants a family-even if she is diagnosed with breast cancer-there is a possibility to have a family life as a breast cancer survivor. And this is an important message for our patients," said Orit Kaidar-Person, MD, lead author of the study, as well as Radiation Oncologist and Head of the Breast Radiation Unit at the Sheba Medical Center in Tel Hashomer, Ramat Gan, Israel.
The key to arriving at the right decision for each patient is through guidance from a multidisciplinary team, Kaidar-Person told Oncology Times. "There is a fear [that] we need to control the disease and, in the first 2 years after breast cancer, we don't know exactly whether the disease is controlled or not."
She said that predicting the course of the disease is important. "It might implicate the type of systemic therapy. We know that many patients suffer from infertility after chemotherapy and systemic therapy. So, I think these data will aid the multidisciplinary team to consult the patient before treatment if she wants to have a family life. And also-after the time of the pregnancy and delivery-to anticipate that they might have more complications."
When she was asked who needed to be the key members of the multidisciplinary team, she said everyone was important. "We cannot do without our radiologists, pathologists, surgeons, OB-GYN, medical oncologists: we're all a team."
Study Details
The study aimed to discover whether breast cancer survivors were at increased risk of obstetric and maternal complications at time of delivery. To do this, the investigators queried the U.S. National Inpatient Sample database records between 2015 and 2018 for hospitalizations associated with deliveries. The incidence of maternal and fetal complications was compared between women with and without a personal history of breast cancer.
The analysis was based on data from 2,103,216 birth-related admissions, among whom 617 (0.03%) of the women were breast cancer survivors. The proportion of breast cancer survivors trying for a baby doubled between 2015 and 2018-from 0.02 percent to 0.04 percent. Half of them were White, a fifth Hispanic, 14 percent Black, 6 percent Asian or Pacific Islander, and 5 percent other or unknown. A smaller proportion of breast cancer survivors trying for a baby were of Hispanic origin. Breast cancer survivors had a higher socioeconomic status and were significantly older compared to other mothers (34 years compared with 28). They were more likely to suffer from pre-existing chronic diseases, including cardiopulmonary disease and diabetes mellitus, and had a higher incidence of multiple gestation (4.4% compared with vs. 1.6%).
Breast cancer survivors also had a higher incidence of acute adverse events at the time of delivery-including fetal distress, preterm labor, cesarean section, and maternal infection. But on multivariate analysis, it was clear that although age, ethnic group, comorbidities, multiple gestations, and a previous breast cancer diagnosis were all associated with an increased risk of an obstetric adverse event, cancer treatment was not. The researchers concluded that, although breast cancer survivors were at increased risk of obstetric and maternal complications, the absolute numbers were low.
Multidisciplinary teams were needed to help before any treatment decision-making, including consultation about fertility and family planning. When pregnancy was desired or planned, the study investigators stated that appropriate screening and management of potential comorbidities were needed and pregnancy should then be managed by the multidisciplinary team.
"The risk of obstetric complications with delivery is relatively low," said Kaidar-Person. "First of all, we need to control the disease. So, if the patient is planned for chemotherapy, she needs to have fertility consultation before having the treatment [so she can] have an ability to decide whether she wants to have a family."
She acknowledged, however, that decision-making was still not an exact science. "We need more data from studies to identify the patients who are prone [to] more complications, according to the systemic therapy, the age, and additional comorbidities they have."
Kaidar-Person said that the number of young women with breast cancer was increasing, even if it was still relatively low compared to the other population of breast cancer.
"Some of these patients will be breast cancer survivors and in their initial phase of wanting a family. In our work, we aimed to look at what happens with deliveries in breast cancer survivors. So, overall, we did see that we had more co-morbidities for breast cancer survivors and more obstetric complications at the time of delivery. But when you look at the absolute rates, [they] are very low. So, this is relatively safe for those patients," she concluded.
Peter M. Goodwin is a contributing writer.