2023-12-07 19:19:00
Becoming a mother after breast cancer is possible. And the dream of holding a child in their arms can also be realized by women who have had hereditary breast cancer related to the presence of alterations in the Brca gene, i.e. 12% of the over 11 thousand Italians of childbearing age who get cancer every year at the breast. In these young people with the ‘Jolie mutation’ – the same one that pushed the American actress to undergo a preventive mastectomy, because it predisposes them to the development of breast and ovarian cancer – pregnancy at the end of oncological treatment was until now not recommended, both for the fear that it entailed a greater risk of relapse for the mother, and for the hypothesis that the treatments she underwent caused dangers for the child. Unfounded fears, as an international study led by Italy now demonstrates.
The maxi Italian studio
The work, described as “the largest conducted to verify the outcomes of pregnancies in young women with breast cancer and BRCA mutations”, was coordinated by the Irccs San Martino polyclinic hospital in Genoa and supported by the Airc Foundation for cancer research . The results, relating to over 4,700 patients from around eighty centers around the world, are published today in ‘Jama’ and presented at the same time as the San Antonio Breast Cancer Symposium, the most important world congress on breast cancer, underway in Texas , USA. “10 years after diagnosis – research shows – one patient in 5 had a pregnancy without any more frequent complications during the wait or greater dangers for unborn children, nor an increase in the probability of the tumor reappearing”.
“These data demonstrate that, after appropriate treatment and a sufficient observation period, pregnancy should no longer be advised against young women with breast cancer and BRCA mutation, because it is possible and safe”, states Matteo Lambertini, associate professor and medical oncologist at the Medical Oncology Clinic of the University of Genoa – Irccs San Martino polyclinic hospital, coordinator of the study together with Eva Blondeaux, medical oncologist at the San Martino Clinical Epidemiology Unit. “Being able to cultivate the hope of building a family in the future, after cancer – he underlines – is of great help to patients because it allows them to better accept the disease and the therapies: the awareness of a possible tomorrow has a significant role in the process of healing”. Results are even more important considering that “the number of young women affected by breast cancer before having had a child is increasing – the experts highlight – also due to the tendency to seek their first pregnancy at an increasingly advanced age. Furthermore, the treatments oncological diseases can lead to a reduction in fertility and the ability to conceive.”
In the survey the data of 4,732 women
The study – details a note – is a retrospective international investigation in which 78 centers globally participated, including very important oncology centers and universities. Data were collected from 4,732 women who received a diagnosis of breast cancer with BRCA mutation within the age of 40. After completing treatment and within 10 years of cancer diagnosis, more than one in 5 (22%) had a pregnancy, with an average time from diagnosis to conception of 3.5 years. Of the 517 women who carried it to term, equal to 79.7% of the total, 91% had a full-term birth and 10% had twins. No higher rates, compared to those expected in the general population, of pregnancy complications or risk of fetal malformations were observed, nor significant differences in disease-free survival between patients who did or did not become pregnant at the end of oncological treatment . “Having a child – the authors point out – does not therefore increase the probability of subsequent tumor recurrence”.
“In the past, pregnancy was advised against these women due to the concern on the one hand that the ‘pregnancy hormones’ could favor the reappearance of breast cancer, being a tumor sensitive to hormones – specifies Lambertini – on the other hand that previous exposure to treatments oncological treatments, including chemotherapy, could have negative consequences on their offspring. Furthermore, to avoid the development of ovarian cancer, these patients are candidates for preventive surgery to remove the ovaries and tubes at a very young age, around the age of 40, and this further reduces their reproductive window. Added to this is the fear of transmitting the mutation to their children, which influences the desire for motherhood in many of these women. All these elements ‘steal the future’ of young patients with hereditary breast cancer , but the new data mark a decisive change of pace.”
“Pregnancy – recommends the coordinator of the maxi study – should no longer be discouraged in women carriers of the ‘Jolie mutation’ who wish to have a child after having undergone adequate treatment for breast cancer and after an appropriate observation period has elapsed from the end of therapy. Indeed, the data show that overall survival can even improve in some cases, in women who realize their desire for a family.”
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