In a retrospective cohort study reported in the Journal of Clinical Oncology, Matteo Lambertini, MD, PhD, and colleagues found that pregnancy after breast cancer in women harboring deleterious germline BRCA mutations did not appear to be associated with worsened maternal prognosis or fetal outcomes.
“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.”— Matteo Lambertini, MD, PhD, and colleagues
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Study Details
The hospital-based retrospective cohort study included data from 1,252 patients from 30 referral centers worldwide who were aged 40 years or younger, were newly diagnosed with stage I to III invasive breast cancer between January 2000 and December 2012, and harbored deleterious germline BRCA1 or BRCA2 mutations. The primary outcome measures were pregnancy rate and disease-free survival among patients with vs without a pregnancy after breast cancer.
Key Findings
Of 1,252 patients (811 with a BRCA1 mutation, 430 with a BRCA2 mutation, and 11 with a BRCA1/2 mutation), 195 had at least one pregnancy after breast cancer (pregnancy rate at 10 years = 19%).
Induced abortions occurred in 16 women (8.2%), and miscarriages occurred in 20 (10.3%); in comparison, the expected rate of miscarriage in the general population is approximately 17%.
Among the 150 patients who gave birth (76.9%; 170 babies), preterm delivery occurred in 10 (9.3%), pregnancy complications in 13 (11.6%), and congenital abnormalities in 2 (1.8%). By comparison, expected rates of preterm delivery and congenital abnormalities are approximately 11% and 3% in the general population.
Median follow-up from breast cancer diagnosis was 8.3 years. No difference between the pregnancy cohort vs the nonpregnancy cohort in disease-free survival was observed in unadjusted analysis (hazard ratio [HR] = 0.96, P = .83) or in multivariate analysis adjusted for age at diagnosis, tumor size, nodal status, hormone receptor status, type of endocrine therapy, breast surgery, and type of BRCA mutation (adjusted HR = 0.87, P =.41).
No significant difference in overall survival was observed in unadjusted analysis (HR = 0.77, P = .36) or in multivariate analysis (adjusted HR = 0.88, P = .66).
The investigators concluded, “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.”
Hatem A. Azim Jr, MD, PhD, of Tecnologico de Monterrey, Centro de Cancer de Mama del Hospital Zambrano Hellion, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the “Les Amis de l’Institut Bordet” Foundation, Italian Association for Cancer Research, and IRCCS Ospedale Policlinico San Martino. For full disclosures of the study authors, visit jco.ascopubs.org.
