Young Women with Breast Cancer: Fertility Preservation Options and Management of Pregnancy-Associated Breast Cancer
Breast cancer is the most common malignancy diagnosed in women of childbearing age. A breast cancer diagnosis in this young patient population can be uniquely complex to navigate when considering the potential impact of fertility loss associated with specific gonadotoxic therapies. Another unique challenge for young breast cancer patients is pregnancy-associated breast cancer (PABC), which occurs in approximately 1 of every 3000 pregnancies. Pregnancy adds a layer of complexity to breast cancer treatment planning as many therapies can affect the developing fetus. These two clinical challenges require nuanced multidisciplinary approaches to facilitate optimal treatment outcomes. We sought to review and summarize the management strategy options for both fertility preservation and PABC.
A guideline and literature review was performed for fertility preservation, young patients with breast cancer, and pregnancy-associated breast cancer.
Fertility preservation options, both established and experimental, are detailed. Suggested clinical practice guidelines for PABC are also presented, which delineate breast cancer treatment recommendations based on pregnancy trimester.
A multidisciplinary approach to patient care, including oncologists and early referral to reproductive specialists, can provide young breast cancer patients with options for fertility preservation. Under the guidance of a multidisciplinary treatment team, PABC can also be diagnosed and treated to permit the best possible outcomes for the mother and the developing fetus.
The authors thank Zachary Pascoe for helpful discussions regarding manuscript preparation. The authors acknowledge financial support from the NIH R01CA214384 (to J. S. Jeruss), A Sister’s Hope Foundation, (J. S. Jeruss), and NIH T32CA009672 (J. S. Jeruss and P. Kandagatla).
Conflict of interest
All authors declare that they have no conflicts of interest.
- 1.American Cancer Society. Breast cancer facts & figures. American Cancer Society, Atlanta; 2017.Google Scholar
- 15.Network NCC. Breast Cancer Version (1.2018), 2018. Retrieved July 2018 at https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf.
- 31.IBCSG 48-14 POSITIVE Trial. Retrieved 15 May 2018 at http://www.ibcsg.org/Public/Health_Professionals/Open_Trials/ibcsg_48-14_positive/Pages/IBCSG48-14POSITIVE.aspx.
- 51.Chen H, Li J, Cui T, Hu L. Adjuvant gonadotropin-releasing hormone analogues for the prevention of chemotherapy-induced premature ovarian failure in premenopausal women. Cochrane Database Syst Rev. 2011;2011(11):CD008018.Google Scholar
- 52.Bedaiwy MA, Abou-Setta AM, Desai N, et al. Gonadotropin-releasing hormone analog cotreatment for preservation of ovarian function during gonadotoxic chemotherapy: a systematic review and meta-analysis. Fertil Steril. 2011;95:906–14.e1–4.Google Scholar
- 56.Lambertini M, Moore HCF, Leonard RCF, et al. Gonadotropin-releasing hormone agonists during chemotherapy for preservation of ovarian function and fertility in premenopausal patients with early breast cancer: a systematic review and meta-analysis of individual patient-level data. J Clin Oncol. 2018;36:1981–90.CrossRefPubMedGoogle Scholar
- 57.Lambertini M, Cinquini M, Moschetti I, et al. Temporary ovarian suppression during chemotherapy to preserve ovarian function and fertility in breast cancer patients: a GRADE approach for evidence evaluation and recommendations by the Italian Association of Medical Oncology. Eur J Cancer. 2017;71:25–33.CrossRefPubMedGoogle Scholar
- 64.Daly MB, Pilarski R, Berry MP, Buys SS, Friedman S, Garber JE, et al. Genetic/familial high-risk assessment: breast and ovarian, Version 1.2018, 2017. Retrieved 14 May 2018 at https://www.nccn.org/professionals/physician_gls/pdf/genetics_screening.pdf.
- 88.Valentin J. Biological effects after prenatal irradiation (embryo and fetus): ICRP Publication 90 approved by the commission in October 2002. Ann ICRP. 2003;33:1–206.Google Scholar
- 92.Azim HA Jr, Peccatori FA, Pavlidis N. Treatment of the pregnant mother with cancer: a systematic review on the use of cytotoxic, endocrine, targeted agents, and immunotherapy during pregnancy: Part I. Solid tumors. Cancer Treat Rev. 2010;36:101–9.Google Scholar
- 95.Cardonick EH, Gringlas MB, Hunter K, Greenspan J. Development of children born to mothers with cancer during pregnancy: comparing in utero chemotherapy-exposed children with nonexposed controls. Am J Obstet Gynecol. 2015;212:658-e651–8.Google Scholar
- 103.Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in pregnancy and lactation, 11 edn. Wolters Kluwer, Alphen aan den Rijn; 2017.Google Scholar