Research examining fertility and attempts at pregnancy among young women after a breast cancer diagnosis has been hampered by short-term follow-up and a lack of prospective assessment of pregnancy attempts. However, a long-term study investigating fertility outcomes among young women who reported attempting pregnancy after a breast cancer diagnosis found that the majority were able to achieve a pregnancy, and most reported experiencing a live birth.
The study’s results may be incorporated into fertility counseling for young patients with breast cancer and highlight the need for accessibility to fertility preservation services for this population, according to the study authors. The study findings were presented by Kimia Sorouri, MD, MPH, a research fellow at Dana-Farber Cancer Institute, Boston, in a press briefing before the 2024 ASCO Annual Meeting.1
Kimia Sorouri, MD
Study Methodology
The researchers analyzed data from women with stage 0 to III breast cancer participating in the Young Women’s Breast Cancer Study (ClinicalTrials.gov identifier NCT01468246). This multicenter, prospective cohort of women diagnosed at age 40 and younger, from 2006 to 2016, focused on any attempt at pregnancy after diagnosis [ie, naturally or with assisted reproductive technology]. Those patients with prior hysterectomy, bilateral oophorectomy, or metastatic disease at diagnosis were excluded from the analysis.
Data on attempting pregnancy and fertility outcomes were obtained from serial surveys. Multivariable logistic regression with stepwise model selection was used to identify factors associated with pregnancy and live birth.
Key Results
The study results showed that among 1,213 eligible participants, 197 reported any attempt at pregnancy (16%) over a median follow-up of 11 years (range, 3–17 years). Among women who attempted pregnancy, median age at diagnosis was 32 (range, 17–40 years). A total of 74% were non-Hispanic White; 41% had stage I breast cancer, 35% had stage II disease, 10% had stage III disease, and 14% had stage 0 disease. Among the participants, 76% had hormone receptor–positive disease; 68% received chemotherapy; 57% received endocrine therapy within 1 year after diagnosis; 13% were BRCA1/2 pathogenic variant carriers; 51% reported financial comfort at baseline; 51% were nulligravida (never pregnant); and 72% were nulliparous (no live births) at diagnosis. A total of 28% had undergone fertility preservation consisting of egg/embryo freezing at diagnosis, and 15% reported a history of infertility before breast cancer diagnosis.
Most participants (73%) reported at least one pregnancy after diagnosis, and 65% reported at least one live birth. Median time from diagnosis to first pregnancy was 48 months (range, 6–125 months).
In the multivariable model, older age at diagnosis (odds ratio [OR] = 0.82 per year increase, 95% confidence interval [CI] = 0.74–0.90, P < .0001) was negatively associated with pregnancy. In contrast, financial comfort at baseline (OR = 2.04, 95% CI = 1.01–4.12, P = .047) was predictive of pregnancy.
For live births, greater age at diagnosis (OR = 0.82 per year increase; 95% CI = 0.76–0.90; P < .0001) was negatively associated, whereas having undergone fertility preservation at diagnosis (OR = 2.78, 95% CI = 1.29–6.00, P = .009) was predictive. History of infertility, nulliparity at diagnosis, tumor characteristics, cancer treatment, race, ethnicity, and BRCA1/2 pathogenic variant status were not associated with either outcome.
Conclusions
This prospective study with more than 10 years of follow-up found that the majority of young breast cancer survivors achieved a pregnancy and most reported a live birth.
The study authors concluded: “This study was designed to address gaps in the literature by reporting on pregnancy and live birth rates among a prospective group of breast cancer patients and survivors who indicated attempting to conceive following their diagnosis of breast cancer. Moreover, the patient population reported on in this study has a median follow-up of over 10 years and includes those with a history of any prior subtype of breast cancer.”
DISCLOSURE: Funding for this study was provided by Susan G. Komen and the Breast Cancer Research Foundation. Dr. Sorouri reported no conflicts of interest.
REFERENCE
1. Sorouri K, Zheng Y, Niman SM, et al: Fertility among young breast cancer survivors attempting pregnancy: A prospective, multicentre cohort study. 2024 ASCO Annual Meeting. Abstract 1518. Presented May 23 at premeeting press briefing.
