2024-01-12 09:58:02
by Vera Martinella
Approximately 3,500 women are diagnosed with breast cancer before age 40. In recent years it has been understood how to preserve fertility without risks for patients and give birth to healthy babies. Policlinico San Martino in Genoa international leader
Post-cancer pregnancy is a topic on which Italy has led the world. Over the last 20 years, the group of researchers from the IRCCS Policlinico San Martino University Hospital in Genoa has presented one study after another in rooms packed with oncologists at the most relevant scientific conferences, from that of the American Society of Clinical Oncology, to San Antonio Breast Cancer Symposium in Texas, to that of the European Society of Medical Oncology, just to name a few. Each study a step forward, a new conquest. The aim was to allow young women who were diagnosed with breast cancer to be able to become mothers once their treatment was finished. Safe both for them, without jeopardizing the effectiveness of anti-cancer therapies, and for the unborn. An objective which, research after research, has now largely been achieved.
Desiderio di maternit
The probability of definitive recovery from breast cancer currently exceeds 60% – explains Lucia Del Mastro, Full Professor and Director of the Medical Oncology Clinic of the IRCCS Policlinico San Martino Hospital, University of Genoa -. We must increasingly set ourselves the goal of preserving the psycho-physical well-being of our patients even after the administration of treatments that are often still invasive. The desire for motherhood is a right that oncology can and must be able to guarantee to a growing number of women. In Genoa we managed to create a virtuous model also for other areas of the Peninsula. At San Martino the patient who has to undergo chemotherapy is able to have direct access to the procedures for freezing oocytes and ovarian tissue. The intuition, which we had over 20 years ago, to create a structured collaboration between the medical oncology department and the medically assisted procreation center directed by Paola Anserini, proved successful.
Preserve fertility
Around 3,500 Italian women every year face a breast cancer diagnosis before the age of 40, when they have not yet had children or have not completed their desire for a family. And the number of cases is increasing, also thanks to the tendency to seek the first pregnancy at an increasingly advanced age. Once upon a time the only solution to having children was to freeze the eggs before the therapy and proceed, once recovered, with in vitro fertilization, then we understood how to put the ovaries to rest during chemotherapy, so as not to damage them and preserve the fertility of young women – recalls Del Mastro -. Some surgeries, some types of radiotherapy and chemotherapy are associated with a high risk of temporary or permanent infertility, in women and men. Many factors can intervene, but today we can and must safeguard the possibility of becoming parents after cancer, there are many strategies.
Just as there are safe strategies for those unfortunate cases in which breast cancer is diagnosed during gestation: there are more or less 150 cases per year in our country and the pregnancy does not always have to be interrupted because research has made progress and they can be saved. mothers, allowing them to give birth to healthy babies, without increasing the risk of pathologies.
Few Italians take advantage of the opportunity
While having a healthy baby without running risks for the mother is feasible today, only 5 women out of 100 are aware that it is possible to preserve fertility. An opportunity that exists, safe for patients (who can also suspend hormonal treatments to carry on with a pregnancy) and for unborn babies, but which in our country is still little exploited, underlines Del Mastro, a pioneer in this sector. From his Genoese group some scientific research has arrived that has improved the approach to fertility preservation at an international level. And on 12 and 13 January, the Back from San Antonio conference will be held in the Ligurian capital, one of the most important national conferences on breast cancer, where the major innovations coming from the American San Antonio Breast Cancer Symposium (which took place in December 2023).
Women with BRCA gene mutation
Even in the USA, oncofertility has been widely highlighted and a study coordinated by San Martino e published simultaneously in the prestigious American magazine JAMA, has added a new piece relevant for young patients with safe BRCA.PMA gene mutation and green light also for mutated BRCA. Illustrating the data was Matteo Lambertini, Associate Professor of Medical Oncology at the IRCCS Policlinico San Martino Hospital, University of Genoa: More than 70 centers around the world were involved and over 4,700 young women with hereditary breast cancer were enrolled to the presence of a mutation in the BRCA genes – explains the oncologist -. After completing oncological treatments and a correct observation period, one in five women managed to get pregnant. Furthermore, having a pregnancy after the diagnosis of breast cancer in BRCA mutated women who have undergone previous chemotherapy is safe both for mothers (i.e. without any increased risk of tumor recurrence) and for children (i.e. without any increased risk of malformations or other pregnancy complications).
Discontinuation of hormone therapy
During the American congress, an in-depth analysis of the international POSITIVE study was also presented: Last year it was demonstrated that young women affected by breast cancer in the initial stage can interrupt adjuvant hormone therapy (i.e. following surgery) for two years to try to get pregnant – clarifies Lambertini -. This year’s data shows that, in these patients, the use of medically assisted procreation techniques is safe without increasing the risk of breast cancer recurrence.
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January 12, 2024 (modified January 12, 2024 | 08:57)
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