Pregnancy After Breast Cancer in Patients With Germline <i>BRCA</i> Mutations

Matteo Lambertini(Ospedale Policlinico San Martino), Lieveke Ameye(Université Libre de Bruxelles), Anne‐Sophie Hamy(Institut Curie), Anna Zingarello(Université Paris-Saclay), Philip D. Poorvu(Dana-Farber Cancer Institute), Estela Carrasco(Vall d'Hebron Hospital Universitari), Albert Grinshpun(Hadassah Medical Center), Sileny Han(KU Leuven), Christine Rousset‐Jablonski(Centre Léon Bérard), Alberta Ferrari(University of Pavia), Shani Paluch–Shimon(Shaare Zedek Medical Center), Laura Cortesi(Azienda Ospedaliero-Universitaria di Modena), Claire Sénéchal(Institut Bergonié), Gianmaria Miolo(Centro di Riferimento Oncologico), Katarzyna Pogoda(The Maria Sklodowska-Curie National Research Institute of Oncology), José Alejandro Pérez Fidalgo(INCLIVA Health Research Institute), Laura De Marchis(Sapienza University of Rome), Riccardo Ponzone(Candiolo Cancer Institute), Luca Livraghi(University of Siena), Maria Del Pilar Estevez-Diz(Universidade de São Paulo), Cynthia Villarreal‐Garza(Hospital Zambrano Hellion), Maria Vittoria Dieci(University of Padua), Florian Clatot(Centre Virchow-Villermé), Martine Berlière(Cliniques Universitaires Saint-Luc), Rossella Graffeo(Institute of Oncology Research), Luís Teixeira(Inserm), Octavi Córdoba(Hospital Universitario Son Espases), Amir Sonnenblick(Tel Aviv Sourasky Medical Center), Helena Luna Pais(Centro Hospitalar Lisboa Norte), Michail Ignatiadis(Institut Jules Bordet), Marianne Paesmans(Université Libre de Bruxelles), Ann H. Partridge(Dana-Farber Cancer Institute), Olivier Caron(Université Paris-Saclay), Claire Saule(Institut Curie), Lucia Del Mastro(Ospedale Policlinico San Martino), Fedro A. Peccatori(European Institute of Oncology), Hatem A. Azim(Hospital Zambrano Hellion)
Journal of Clinical Oncology
July 16, 2020
10.1200/jco.19.02399
Cited by 93Open Access
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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.

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