Pregnancy After Estrogen Positive Breast Cancer

Ovarian Tissue Cryopreservation And Transplantation: Recent Progress And The Issues Specific Tobrca Carriers

Potential future strategies to use cryopreserved ovarian tissue when ovarian transplantation is not considered safe. When ovarian cryopreservation is the only available option for fertility preservation but the future transplantation of ovarian tissue is not considered safe, such as with ovarian metastasis or a high risk for ovarian cancer development in women with BRCA mutations, experimental strategies such as in vitro follicle growth and xenografting may become available to mature oocytes ex vivo in the future. These options are currently theoretical in the clinical setting.

Is It Safe For Me To Get Pregnant Following Breast Cancer Treatment

More good news: Pregnancy following curative treatment for breast cancer does not increase the risk for relapse of the cancer, according to several studies.

In the past, breast cancer survivors were encouraged to wait at least two years following treatment before attempting pregnancy. More recent evidence suggests that timing has no impact on breast cancer relapse risk, whether the pregnancy occurs less than or more than two years after completing treatment.

Additionally, it was once supposed that pregnancy following treatment for estrogen receptor-expressing breast cancer would lead to a higher risk for cancer relapse due to the hormonal changes associated with pregnancy. However, pregnancy does not make it more likely to have relapse of ER positive breast cancer compared to women with ER positive cancers who do not subsequently become pregnant.

Pregnancy Safe For Women With Estrogen Receptor

Pregnancy is safe and should not be discouraged following a diagnosis of breast cancer, regardless of estrogen receptor status, according to results of a multicenter case-control study reported during the 8th European Breast Cancer Conference in Vienna, Austria, March 21.

In addition, Hatem A. Azim, Jr., MD, Jules Bordet Institute, Brussels, Belgium, and colleagues found that pregnancy within two years after a diagnosis of breast cancer appeared to have a protective effect.

They enrolled 1,207 women 333 who had become pregnant following a breast cancer diagnosis were matched with 874 similar patients with breast cancer who did not become pregnant. A total of 57% were estrogen receptor-positive and 44% were node positive. Mean age was 34 years . For patients with ER+ tumors, the one-year end point was disease-free survival, calculated from date of conception or, in the control group, date of diagnosis plus the time between diagnosis and conception of the matched case. In women with ER-negative disease, disease-free survival was a two-year end point.

Results of this study provide strong evidence to help counsel women seeking to become pregnant following completion of breast cancer therapy. The study did not address optimal duration of adjuvant hormonal therapy.

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Yes A Pregnancy After Breast Cancer Is Safe

Nick Mulcahy

CHICAGO It’s a finding that has been called “comforting,” “reassuring,” and “good news,” here at the American Society of Clinical Oncology 2017 Annual Meeting.

The warm words are for the long-term results of a study of women who became pregnant after an early stage breast cancer diagnosis.

Lead study author Matteo Lambertini, MD, a medical oncologist at the Institut Jules Bordet in Brussels, Belgium, reported that, after a median follow-up of about 12 years from cancer diagnosis among 1200 women, there was no difference in disease-free survival between women who became pregnant and those who did not .

In other words, a pregnancy did not raise the risk of breast cancer recurrence or death.

Importantly, the finding also applied to women with estrogen-receptor -positive disease , the primary study outcome.

Pregnancy after breast cancer is “safe” and “should not be discouraged,” summarized Dr Lambertini during a press conference.

“It’s wonderful to have these data,” said Claudine Isaacs, MD, a medical oncologist at Georgetown Lombardi Comprehensive Cancer Center in Washington DC, who was not involved with the research. The new study is distinguished from similar past research by its large size, long-term follow-up, and detail of patients’ receptor status, she pointed out.

However, the study is not the final word on managing patients with early stage breast cancer who want to get pregnant after treatment, said another expert.

Study In Mice Suggests That Expression Of Estrogen

by Georgetown University Medical Center

In a study using a first-of-its kind mouse model of aging that mimics breast cancer development in estrogen receptor-positive post-menopausal women, investigators at Georgetown Lombardi Comprehensive Cancer Center and colleagues have determined that over-expression, or switching on of the Esr1 gene, could lead to elevated risk of developing estrogen receptor-positive breast cancer in older women.

In a second study from the same research lab, investigators found that in the specially bred mice given anti-hormonal drugs similar to those currently used by women to lower their breast cancer risk, the elevated risk of developing breastcancer due to over-expression of Esr1 could be lowered or reversed.

The findings appeared simultaneously December 1, 2022, in the American Journal of Pathology.

“In the clinic, we currently use tests for over-expression of particular patterns of genes to predict the probability of whether a woman’s breast cancer could become metastatic,” says Priscilla Furth, M.D., professor of oncology and medicine at Georgetown Lombardi and corresponding author of both studies. “If validated in human studies, detection of over-expression of Esr1-related genes could be a new signature to add to current prognostic tools that would help post-menopausal women at risk for estrogen receptor-positive breast cancer decide what their best risk reduction strategy might be.”

More information:American Journal of Pathology

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Why Are Triple Negative Breast Cancers More Common

Triple-negative breast cancer cells dont have estrogen or progesterone receptors and also dont make any or too much of the protein called HER2. These cancers tend to be more common in women younger than 40 years of age, who are Black, or who have a mutation in the BRCA1 gene. Triple-negative breast cancers grow and spread faster than most other types of breast cancer. Because the cancer cells dont have hormone receptors, hormone therapy is not helpful in treating these cancers. And because they dont have too much HER2, drugs that target HER2 arent helpful, either. Chemotherapy can still be useful. See Triple-negative Breast Cancer to learn more.

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Hormone Therapy After Surgery For Breast Cancer

After surgery, hormone therapy can be given to reduce the risk of the cancer coming back. Taking an AI, either alone or after tamoxifen, has been shown to work better than taking just tamoxifen for 5 years.

These hormone therapy schedules are known to be helpful for women who are post-menopausal when diagnosed:

• Tamoxifen for 2 to 3 years, followed by an AI for 2 to 3 years
• Tamoxifen for 2 to 3 years, followed by an AI for 5 years
• Tamoxifen for 4½ to 6 years, followed by an AI for 5 years
• Tamoxifen for 5 to 10 years
• An AI for 5 to 10 years
• An AI for 2 to 3 years, followed by tamoxifen for 2 to 3 years
• For women who are unable to take an AI, tamoxifen for 5 to 10 years is an option

For most post-menopausal women whose cancers are hormone receptor-positive, most doctors recommend taking an AI at some point during adjuvant therapy. Standard treatment is to take these drugs for about 5 years, or to take in sequence with tamoxifen for 5 to 10 years. For women at a higher risk of recurrence, hormone treatment for longer than 5 years may be recommended. Tamoxifen is an option for some women who cannot take an AI. Taking tamoxifen for 10 years is considered more effective than taking it for 5 years, but you and your doctor will decide the best schedule of treatment for you.

These therapy schedules are known to be helpful forwomen who are pre-menopausal when diagnosed:

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Breast Cancer Surgery During Pregnancy

Surgery to remove the cancer in the breast and nearby lymph nodes is a major part of treatment for any woman with early breast cancer, and generally is safe in pregnancy.

Options for breast cancer surgery might include:

• Removing the entire breast
• Removing just the part containing the cancer

The type of surgery a woman might have depends on the extent of her cancer and when the cancer is diagnosed during the pregnancy.

Should I Use Ivf To Increase My Chances Of Getting Pregnant

IFV is an option for many women after breast cancer, but check with your doctor to make sure it is safe for you to take fertility medicine. If you have had hormone-sensitive cancer, there are medications you can take to reduce the amount of estrogen in your body during your fertility treatment. The costs of IVF should be considered, too. Your health insurance provider may be able to cover some of these expenses.

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How Long To Wait Before Trying To Get Pregnant

Recent research has shown that waiting to try for a pregnancy for longer than 10 months after the end of chemotherapy does not increase recurrence risk or have a survival benefit. Other research has found that waiting only 6 months also did not increase risk.

Women trying to get pregnant naturally may be advised to wait 6 months after chemotherapy to allow time for damaged eggs to pass from the body.

Because the risk of recurrence in women treated for early-stage breast cancer is highest in the first two years after treatment, doctors may suggest waiting 2 to 3 years before getting pregnant.

Whatever time frame your doctor recommends, talk about why that length of time is being suggested and whether you will be taking tamoxifen or other medicine.

What Is A Hormone Receptor

Hormones are chemical messengers that circulate in the bloodstream. Hormone receptors are proteins located in and around breast cells. When the corresponding hormone binds to a receptor, it tells the cells how to grow and divide.

In the case of breast cancer, these receptors allow abnormal cells to grow out of control, which results in a tumor.

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Other Concerns About Having A Child After Cancer Treatment

Risk of children getting cancer. Many people who have had cancer worry that their children may get cancer, too. Research shows that children of people with cancer and cancer survivors do not have a higher risk of the disease. But a few cancers are passed from parents to children through genes. If you have one of these hereditary cancers, there may be higher risk. Talk with your health care provider or a genetic counselor about having children. They can help you understand cancer risk and genetics.

Risk of cancer recurrence. Studies show that getting pregnant does not seem to make cancer return. Some health care providers advise breast cancer survivors to wait 2 years before trying to get pregnant. There is a link between some hormones that rise during pregnancy and the growth of breast cancer cells. But there is no scientific proof that cancer risk increases if a woman gets pregnant within 2 years of completing treatment. Some studies even suggest that risk of breast cancer recurrence is lower after a subsequent pregnancy.

For some survivors, getting pregnant may require stopping certain medications. But stopping medications such as tamoxifen or imatinib raises the risk of cancer returning. People who are planning to have children need to talk about how much risk they are willing to accept. Talk with your health care team and a fertility specialist before trying to get pregnant after cancer.

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Acupoint selection: 4 general points + syndrome differentiation acupoints , and adjust acupoints according to symptoms every week.

Frequency: 3 times a week for a total of 8 weeks of continuous treatment.

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I Havent Started Cancer Treatment Yet Is There Anything I Can Do Now To Preserve My Fertility

For women who want to have children after breast cancer, there are several ways to preserve fertility before your treatments begin. Talk with your doctor, as well as a fertility specialist, before making treatment plans. Ask what your options are to increase fertility. You may choose to freeze an egg, store embryos before cancer treatment begins, or take medication to protect your ovaries from damage. The sooner you speak with a fertility specialist, the greater your chances are of preserving your fertility after cancer.

What If I Cant Get Pregnant After Cancer Treatment

Women who are unable to get pregnant after cancer may wish to consider gestational surrogacy. With gestational surrogacy, an embryo is created via IVF, using the eggs and sperm of the intended parents or donors, and then transferred to a surrogate. The surrogate mother is not biologically related to the child she carriesbut you, and/or your partner, may be, if you choose to donate your own eggs and/or sperm.

With gestational surrogacy, you may use your own eggs, or donor eggs, which can be fertilized with your partners sperm, or donor sperm. Gestational surrogacy is a great option for women who have frozen an egg or an embryo prior to their cancer treatment, or women who are able to get pregnant, but unable to carry the baby to term.

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Does Pregnancy Affect The Risk Of Other Cancers

Research has shown the following with regard to pregnancy and the risk of other cancers:

• Women who have had a full-term pregnancy have reduced risks of ovarian and endometrial cancers. Furthermore, the risks of these cancers decline with each additional full-term pregnancy.
• Pregnancy also plays a role in an extremely rare type of tumor called a gestational trophoblastic tumor. In this type of tumor, which starts in the uterus, cancer cells grow in the tissues that are formed following conception.
• There is some evidence that pregnancy-related factors may affect the risk of other cancer types, but these relationships have not been as well studied as those for breast and gynecologic cancers. The associations require further study to clarify the exact relationships.

As in the development of breast cancer, exposures to hormones are thought to explain the role of pregnancy in the development of ovarian, endometrial, and other cancers. Changes in the levels of hormones during pregnancy may contribute to the variation in risk of these tumors after pregnancy .

If I Have A Genetic Mutation Associated With My Cancer Is There Anything I Can Do To Keep From Passing The Mutation To My Future Children

To keep from passing on an inherited genetic mutation to your child, you could consider in vitro fertilization to create embryos that can be tested for the mutation. During IVF, you will take hormones to stimulate your ovaries for about 10 days. Then, your eggs will be removed and fertilized with sperm to create embryos. About 5 days later, cells will be removed from the embryos to be tested for the mutation. This is called preimplantation genetic testing . When youre ready to try to get pregnant, you can choose to use only embryos without the mutation. PGT can also be done if you froze eggs or embryos before your treatment. IVF and PGT can be expensive and may not be covered by insurance.

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Treating Breast Cancer During Pregnancy

If you are diagnosed with breast cancer while pregnant, your treatment options will be more complicated because you will want to get the best treatment for your cancer while also protecting the baby. The type and timing of treatment will need to be planned carefully and coordinated between your cancer care team and your obstetrician.

When treating a pregnant woman with breast cancer, the goal is the same as when treating a non-pregnant woman: to cure the cancer whenever possible, or to control it and keep it from spreading if it cant be cured. But the extra concern of protecting a growing fetus may make treatment more complicated.

Chemotherapys Impact On Fertility

Chemotherapy can damage or destroy eggs, increasing your risk of infertility immediately or years after treatment ends. Your age and the type and total amount of chemotherapy contribute to infertility risk. The younger you are and the less chemotherapy you have had, the more likely you are to remain fertile. Women under age 35 are most likely to have their periods return after treatment.

This risk calculator created by Livestrong Fertility can help to estimate your risk of infertility after chemo.

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Treatment Tailoring In Hormone

RT-PCR, reverse transcriptase-PCR. Modified from Sotiriou & Pusztai .

One of such tools, the Oncotype DX, merits to be addressed in more details . This test was developed to answer the following question Is it possible to identify a woman with hormone receptor-positive, lymph node-negative breast cancer, for whom it may be necessary something more than just tamoxifen alone? Among the 16 genes that the Oncotype DX analyzes, some are related to the ER , other related to cell proliferation , and other, like HER2, which are not functionally related. The relative expression of these genes compared with that of five reference genes whose expression does not correlate with tumor aggressiveness is combined by a mathematical formula that results in a continuous score ) that is directly proportional to the risk of metastatic relapse. The RS has been into divided into three risk categories by cutoffs that were established studying the clinical outcome of women enrolled in the tamoxifen arm of the NSABP B-20 clinical trial . The low-risk group has been defined by a RS< 18, the intermediate by a RS between 18 and 30, and the high risk by a RS> 30.

RS, recurrence score NSABP, national surgical adjuvant breast and bowel project ECOG, eastern cooperative oncology group SWOG, south western oncology group.