Matteo Lambertini1,2, Lieveke Ameye3, Anne-Sophie Hamy4, Anna Zingarello5, Philip D Poorvu6, Estela Carrasco7, Albert Grinshpun8, Sileny Han9, Christine Rousset-Jablonski10, Alberta Ferrari11, Shani Paluch-Shimon12, Laura Cortesi13, Claire Senechal14, Gianmaria Miolo15, Katarzyna Pogoda16, Jose Alejandro Pérez-Fidalgo17, Laura De Marchis18, Riccardo Ponzone19, Luca Livraghi20,21, Maria Del Pilar Estevez-Diz22, Cynthia Villarreal-Garza23,24, Maria Vittoria Dieci25,26, Florian Clatot27, Martine Berlière28, Rossella Graffeo29, Luis Teixeira30, Octavi Córdoba31, Amir Sonnenblick32, Helena Luna Pais33, Michail Ignatiadis34, Marianne Paesmans3, Ann H Partridge6, Olivier Caron5, Claire Saule35, Lucia Del Mastro1,36, Fedro A Peccatori37, Hatem A Azim24. 1. Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy. 2. Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy. 3. Data Centre, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium. 4. Department of Medical Oncology, Institut Curie, Paris, France. 5. Département Médecine Oncologique, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France. 6. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA. 7. Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain. 8. Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. 9. Multidisciplinary Breast Center, Department of Gynaecology, University Hospitals Leuven, Department of Oncology, KU Leuven, Leuven, Belgium. 10. Department of Surgery, Centre Léon Bérard, Lyon, France. 11. Department of Surgical Sciences, General Surgery III-Breast Surgery, Fondazione IRCCS Policlinico San Matteo, and Department of Clinical Surgical Sciences, University of Pavia, Pavia, Italy. 12. Breast Oncology Unit, Shaare Zedek Medical Centre, Jerusalem, Israel. 13. Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy. 14. Cancer Genetics Unit, Bergonie Institute, Bordeaux, France. 15. Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy. 16. Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. 17. Department of Medical Oncology, INCLIVA University Hospital of Valencia, CIBERONC, Valencia, Spain. 18. Division of Medical Oncology, Department of Radiological, Oncological and Pathological Sciences, "La Sapienza" University of Rome, Rome, Italy. 19. Gynecological Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy. 20. Medical Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy. 21. University of Siena, Siena, Italy. 22. Department of Oncology, Instituto do Cancer do Estado de São Paulo-Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 23. Departamento de Investigacion y de Tumores Mamarios, Instituto Nacional de Cancerologia, Mexico City, Mexico. 24. Tecnologico de Monterrey, Centro de Cancer de Mama del Hospital Zambrano Hellion, Nuevo Leon, Mexico. 25. Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy. 26. Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy. 27. Department of Medical Oncology, Centre Henri Becquerel, Rouen, France. 28. Department of Oncology, Breast Clinic, Cliniques Universitaires Saint-Luc UCL, Brussels, Belgium. 29. Breast Unit of Southern Switzerland, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland. 30. Breast Disease Unit Saint-Louis Hospital, APHP, Université de Paris, Inserm, U976 HIPI Unit, F-75010, Paris, France. 31. Obstetrics and Gynecology Department, Hospital Universitari Son Espases, Palma, Spain. 32. Oncology Division, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv, Israel. 33. Department of Medical Oncology, Centro Hospitalar Universitário Lisboa Norte-Hospital de Santa Maria, Lisbon, Portugal. 34. Department of Medical Oncology, Institut Jules Bordet and Université Libre de, Brussels, Belgium. 35. Department of Genetics, Institut Curie, Paris, France. 36. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy. 37. Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy.
Abstract
PURPOSE: Young women with germline BRCA mutations have unique reproductive challenges. Pregnancy after breast cancer does not increase the risk of recurrence; however, very limited data are available in patients with BRCA mutations. This study investigated the impact of pregnancy on breast cancer outcomes in patients with germline BRCA mutations. PATIENTS AND METHODS: This is an international, multicenter, hospital-based, retrospective cohort study. Eligible patients were diagnosed between January 2000 and December 2012 with invasive early breast cancer at age ≤ 40 years and harbored deleterious germline BRCA mutations. Primary end points were pregnancy rate, and disease-free survival (DFS) between patients with and without a pregnancy after breast cancer. Pregnancy outcomes and overall survival (OS) were secondary end points. Survival analyses were adjusted for guarantee-time bias controlling for known prognostic factors. RESULTS: Of 1,252 patients with germline BRCA mutations (BRCA1, 811 patients; BRCA2, 430 patients; BRCA1/2, 11 patients) included, 195 had at least 1 pregnancy after breast cancer (pregnancy rate at 10 years, 19%; 95% CI, 17% to 22%). Induced abortions and miscarriages occurred in 16 (8.2%) and 20 (10.3%) patients, respectively. Among the 150 patients who gave birth (76.9%; 170 babies), pregnancy complications and congenital anomalies occurred in 13 (11.6%) and 2 (1.8%) cases, respectively. Median follow-up from breast cancer diagnosis was 8.3 years. No differences in DFS (adjusted hazard ratio [HR], 0.87; 95% CI, 0.61 to 1.23; P = .41) or OS (adjusted HR, 0.88; 95% CI, 0.50 to 1.56; P = .66) were observed between the pregnancy and nonpregnancy cohorts. CONCLUSION: Pregnancy after breast cancer in patients with germline BRCA mutations is safe without apparent worsening of maternal prognosis and is associated with favorable fetal outcomes. These results provide reassurance to patients with BRCA-mutated breast cancer interested in future fertility.
PURPOSE: Young women with germline BRCA mutations have unique reproductive challenges. Pregnancy after breast cancer does not increase the risk of recurrence; however, very limited data are available in patients with BRCA mutations. This study investigated the impact of pregnancy on breast cancer outcomes in patients with germline BRCA mutations. PATIENTS AND METHODS: This is an international, multicenter, hospital-based, retrospective cohort study. Eligible patients were diagnosed between January 2000 and December 2012 with invasive early breast cancer at age ≤ 40 years and harbored deleterious germline BRCA mutations. Primary end points were pregnancy rate, and disease-free survival (DFS) between patients with and without a pregnancy after breast cancer. Pregnancy outcomes and overall survival (OS) were secondary end points. Survival analyses were adjusted for guarantee-time bias controlling for known prognostic factors. RESULTS: Of 1,252 patients with germline BRCA mutations (BRCA1, 811 patients; BRCA2, 430 patients; BRCA1/2, 11 patients) included, 195 had at least 1 pregnancy after breast cancer (pregnancy rate at 10 years, 19%; 95% CI, 17% to 22%). Induced abortions and miscarriages occurred in 16 (8.2%) and 20 (10.3%) patients, respectively. Among the 150 patients who gave birth (76.9%; 170 babies), pregnancy complications and congenital anomalies occurred in 13 (11.6%) and 2 (1.8%) cases, respectively. Median follow-up from breast cancer diagnosis was 8.3 years. No differences in DFS (adjusted hazard ratio [HR], 0.87; 95% CI, 0.61 to 1.23; P = .41) or OS (adjusted HR, 0.88; 95% CI, 0.50 to 1.56; P = .66) were observed between the pregnancy and nonpregnancy cohorts. CONCLUSION: Pregnancy after breast cancer in patients with germline BRCA mutations is safe without apparent worsening of maternal prognosis and is associated with favorable fetal outcomes. These results provide reassurance to patients with BRCA-mutated breast cancer interested in future fertility.
Authors: J Alejandro Rauh-Hain; Jose Zubizarreta; Roni Nitecki; Alexander Melamed; Shuangshuang Fu; Kirsten Jorgensen; Paula C Brady; Valerie L Baker; Mariana Chavez-MacGregor; Sharon H Giordano; Nancy L Keating Journal: Cancer Date: 2022-06-29 Impact factor: 6.921
Authors: Roni Nitecki; Shuangshuang Fu; Kirsten A Jorgensen; Lauren Gray; Carolyn Lefkowits; Benjamin D Smith; Larissa A Meyer; Alexander Melamed; Sharon H Giordano; Pedro T Ramirez; Jose Alejandro Rauh-Hain Journal: Int J Gynecol Cancer Date: 2021-11-16 Impact factor: 4.661
Authors: Josephine Nsaful; Verna Vanderpuye; Aba Anoa Scott; Florence Dedey; Samuel A Oppong; Rita Appiah-Danquah; Nelson Damale; Benjamin Fenu; Theodore Wordui; Joel Yarney; Joe Nat Clegg-Lamptey Journal: Ecancermedicalscience Date: 2020-11-10
Authors: Lucia Del Mastro; Hatem A Azim; Matteo Lambertini; Marcello Ceppi; Anne-Sophie Hamy; Olivier Caron; Philip D Poorvu; Estela Carrasco; Albert Grinshpun; Kevin Punie; Christine Rousset-Jablonski; Alberta Ferrari; Shani Paluch-Shimon; Angela Toss; Claire Senechal; Fabio Puglisi; Katarzyna Pogoda; Jose Alejandro Pérez-Fidalgo; Laura De Marchis; Riccardo Ponzone; Luca Livraghi; Maria Del Pilar Estevez-Diz; Cynthia Villarreal-Garza; Maria Vittoria Dieci; Florian Clatot; Francois P Duhoux; Rossella Graffeo; Luis Teixeira; Octavi Córdoba; Amir Sonnenblick; Arlindo R Ferreira; Ann H Partridge; Antonio Di Meglio; Claire Saule; Fedro A Peccatori; Marco Bruzzone; Marie Daphne t'Kint de Roodenbeke; Lieveke Ameye; Judith Balmaña Journal: NPJ Breast Cancer Date: 2021-02-12