Abstract
Around 6 % of breast cancer cases occur in women younger than 40 years; these patients show specific issues compared to older women. The effects of local and systemic treatments such as the distortion of body image, sexuality complaints, and fertility reduction have a higher impact in this population of young women. Fertility issues should be discussed before starting any type of anticancer treatment. The optimal type of fertility preservation, the endocrine treatment duration, and the effect of subsequent pregnancies on breast cancer prognosis remain research priorities. Currently, fertility preservation techniques rely on cryopreservation of embryos, cryopreservation of mature oocytes, cryopreservation of ovarian tissue and on the administration of GnRHa concomitant to chemotherapy. Advantages and disadvantages of each technique must be evaluated in each single patient. Many studies have shown that pregnancy after breast cancer does not impair the prognosis, both in ER+ and ER− patients; a protective effect of pregnancy has even been suggested. Young patients should not be undertreated to satisfy their eagerness for pregnancy; physicians should share with them all the available options for fertility preservation and the evidence about safety of pregnancy after cancer, to make a customized and informed decision.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Cardoso F, Loibl S, Pagani O, Graziottin A, Panizza P, Martincich L, Gentilini O, Peccatori F, Fourquet A, Delaloge S, Marotti L, Penault-Llorca F, Kotti-Kitromilidou AM, Rodger A, Harbeck N, European Society of Breast Cancer Specialists (2012) The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer. Eur J Cancer 48(18):3355–3377
Von Wolff M, Montag M, Dittrich R, Denschlag D, Nawroth F, Lawrenz B (2011) Fertility preservation in women–a practical guide to preservation techniques and therapeutic strategies in breast cancer, Hodgkin’s lymphoma and borderline ovarian tumours by the fertility preservation network FertiPROTEKT. Arch Gynecol Obstet 284(2):427–435
González C, Boada M, Devesa M, Veiga A (2012) Concise review: fertility preservation: an update. Stem Cells Transl Med 1:668–672
Cold S, Düring M, Ewertz M, Knoop A, Møller S (2005) Does timing of adjuvant chemotherapy influence the prognosis after early breast cancer? Results of the Danish Breast Cancer Cooperative Group (DBCG). Br J Cancer 93(6):627–632
Kim SS, Klemp J, Fabian C (2011) Breast cancer and fertility preservation. Fertil Steril 95:1535–1543
Oktay K, Buyuk E, Libertella N et al (2005) Fertility preservation in breast cancer patients: a prospective controlled comparison of ovarian stimulation with tamoxifen and letrozole for embryo cryopreservation. J Clin Oncol 23:4347–4353
Rodriguez-Wallberg KA, Oktay K (2010) Fertility preservation in women with breast cancer. Clin Obstet Gynecol 53(4):753–762
Azim AA, Costantini-Ferrando M, Oktay K (2008) Safety of fertility preservation by ovarian stimulation with letrozole and gonadotropins in patients with breast cancer: a prospective controlled study. J Clin Oncol 26(16):2630–2635. doi:10.1200/JCO.2007.14.8700
Wolff M, Donnez J, Hovatta O, Keros V, Maltaris T, Montag M, Salle B, Sonmezer M, Andersen CY (2009) Cryopreservation and autotransplantation of human ovarian tissue prior to cytotoxic therapy—a technique in its infancy but already successful in fertility preservation. Eur J Cancer 45:1547–1553
Recchia F, Saggio G, Amiconi G et al (2006) Gonadotropin-releasing hormone analogues added to adjuvant chemotherapy protect ovarian function and improve clinical outcomes in young women with early breast carcinoma. Cancer 106(3):514
Loren AW, Mangu PB, Beck LN, Brennan L, Magdalinski AJ, Partridge AH, Quinn G, Wallace WH, Oktay K, American Society of Clinical Oncology (2013) Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 31(19):2500–2510
Peccatori FA, Azim HA Jr, Orecchia R et al (2013) Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 24(Suppl)6:vi 160–170.
Del Mastro L, Boni L, Michelotti A, Gamucci T, Olmeo N, Gori S, Giordano M, Garrone O, Pronzato P, Bighin C, Levaggi A, Giraudi S, Cresti N, Magnolfi E, Scotto T, Vecchio C, Venturini M (2011) Effect of the gonadotropin-releasing hormone analogue triptorelin on the occurrence of chemotherapy-induced early menopause in premenopausal women with breast cancer: a randomized trial. JAMA 306(3):269–276
Gerber B, von Minckwitz G, Stehle H, Reimer T, Felberbaum R, Maass N, Fischer D, Sommer HL, Conrad B, Ortmann O, Fehm T, Rezai M, Mehta K, Loibl S, German Breast Group Investigators (2011) Effect of luteinizing hormone-releasing hormone agonist on ovarian function after modern adjuvant breast cancer chemotherapy: the GBG 37 ZORO study. J Clin Oncol 29(17):2334–2341
Azim A Jr, Santoro L, Pavlidis N, Gelber S, Kroman N, Azim H, Peccatori FA (2011) Safety of pregnancy following breast cancer diagnosis: a meta-analysis of 14 studies. Eur J Cancer 47:74–83
Kranick JA, Schaefer C, Rowell S, Desai M, Petrek JA, Hiatt RA, Senie RT (2010) Is pregnancy after breast cancer safe? Breast J 16(4):404–411
Azim HA Jr, Kroman N, Paesmans M, Gelber S, Rotmensz N, Ameye L, De Mattos-Arruda L, Pistilli B, Pinto A, Jensen MB, Cordoba O, de Azambuja E, Goldhirsch A, Piccart MJ, Peccatori FA (2013) Prognostic impact of pregnancy after breast cancer according to estrogen receptor status: a multicenter retrospective study. J Clin Oncol 31(1):73–79
Polyak K (2006) Pregnancy and breast cancer: the other side of the coin. Cancer Cell 9(3):151–153
Verkooijen HM, Lim GH, Czene K et al (2010) Effect of childbirth after treatment on long-term survival from breast cancer. Br J Surg 97(8):1253–1259
Azim HA, Peccatori FA, de Azambuja E, Piccart MJ (2011) Motherhood after breast cancer: searching for la dolce vita. Expert Rev Anticancer Ther 11(2):287–298
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365(9472):1687–1717
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 International Society of Gynecological Endocrinology
About this chapter
Cite this chapter
Biglia, N., D’Alonzo, M., Pecchio, S., Ottino, M.C., Daniele, A., Menato, G. (2015). Fertility Preservation and Pregnancy After Breast Cancer: When and How?. In: Fauser, B.C.J.M., Genazzani, A.R. (eds) Frontiers in Gynecological Endocrinology. ISGE Series. Springer, Cham. https://doi.org/10.1007/978-3-319-09662-9_20
Download citation
DOI: https://doi.org/10.1007/978-3-319-09662-9_20
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-09661-2
Online ISBN: 978-3-319-09662-9
eBook Packages: MedicineMedicine (R0)