Pregnancy After Breast Cancer in Patients With Germline BRCA Mutations

Matteo Lambertini, Lieveke Ameye, Anne Sophie Hamy, Anna Zingarello, Philip D. Poorvu, Estela Carrasco, Albert Grinshpun, Sileny Han, Christine Rousset-Jablonski, Alberta Ferrari, Shani Paluch-Shimon, Laura Cortesi, Claire Senechal, Gianmaria Miolo, Katarzyna Pogoda, Jose Alejandro Pérez-Fidalgo, Laura De Marchis, Riccardo Ponzone, Luca Livraghi, Maria Del Pilar Estevez-DizCynthia Villarreal-Garza, Maria Vittoria Dieci, Florian Clatot, Martine Berlière, Rossella Graffeo, Luis Teixeira, Octavi Córdoba, Amir Sonnenblick, Helena Luna Pais, Michail Ignatiadis, Marianne Paesmans, Ann H. Partridge, Olivier Caron, Claire Saule, Lucia Del Mastro, Fedro A. Peccatori, Hatem A. Azim

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)3012-3023
Number of pages12
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology
Volume38
Issue number26
DOIs
Publication statusPublished - Sep 10 2020

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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