In women who were diagnosed with breast cancer while still fertile, “pausing” hormone therapy to try to become pregnant and resorting to assisted reproductive techniques does not appear to increase the risk of recurrence, at least in the short term. The positive message – but which still needs to be taken with caution – comes from the international Positive study, the latest data of which were recently presented at the San Antonio Breast Cancer Symposium (SABCS), the most important scientific conference on breast cancer in the world.
Therapy paused to try to get pregnant
Last year the first results of the Positive study (also presented at the San Antonio Breast Cancer Symposium) had demonstrated something very important: that, in young people with hormone-sensitive breast cancer, interrupting hormone therapy after a year and a half to try to get pregnant, and then restarting it after giving birth , did not increase the risk of relapse in the following 40 months. A very reassuring result that can change the treatment protocol for many of the approximately 11 thousand women who receive a diagnosis of breast cancer of childbearing age in Italy every year.
by GIULIA TONIUTTI
In fact, for patients with breast cancer with positive hormone receptors, anti-hormonal therapy after the operation lasts from five to 10 years. Currently you have to wait until it’s over before trying to get pregnant. The study shows, however, that if the anti-hormonal treatment is interrupted after the first 18 months and the patient is left free from treatment for two years and then resumes, the pregnancy is safe and does not increase the risk of recurrence of the disease.
Natural and assisted pregnancies: safe in the same way?
This new analysis takes a step forward: “The researchers evaluated whether, among the patients who interrupted therapy, those with a pregnancy obtained through medically assisted procreation techniques had a different disease prognosis compared to those who had had natural pregnancies – he explains at Breast Health Lucia Del Mastrofull professor and director of the Medical Oncology Clinic of the IRCCS San Martino Polyclinic in Genoa, among the centers that participated in the trial – The results did not reveal a negative impact on the prognosis of the various techniques, although the observation period – three years – is still short.”
Age: how it affects the pregnancy rate
The study involved 500 women: one third under 35, and two thirds over 35. Of these, 368 (74%) managed to get pregnant and 64% carried it to term. As expected, a strong association emerged between age and the time it takes to become pregnant: one year after stopping hormone therapy, 64% of women under 35 were pregnant, 54% of those aged 35-39, and 38% of women aged 40-42.
by Tiziana Moriconi
About half of the women in the study used hormonal stimulation
As the study coordinator says, Hatem A. Azim Jrassociate professor at the School of Medicine and Breast Cancer Center of the Monterrey Institute of Technology (Mexico) at the site MedScape, half of the sample (51%) had resorted to some form of fertility preservation at the time of diagnosis (and before participation in the Positive study): in the majority of cases it involved ovarian stimulation necessary for egg retrieval, the cryopreservation of these or of the embryos (obtained with in vitro fertilization). After the start of the study, however, 43% of the women enrolled resorted to some assisted reproduction technique: above all ovarian stimulation for in vitro fertilization, or the transfer of previously obtained and cryopreserved embryos.
by Tiziana Moriconi
Cryopreservation and embryo transfer: the most effective technique
Of all the possibilities, the latter proved to be the most effective, with a percentage of pregnancies obtained more than double compared to the other techniques. However, even for assisted reproduction, as is known, age makes a difference in terms of chances: women under 35 who resorted to assisted reproduction had a 50% higher chance of becoming pregnant than those who had 35-39 years old, and 84% higher than women aged 40-42 years.
by Barbara Orrico
Three-year data on the impact of assisted reproduction on prognosis
Coming to the data on the course of the disease, the most awaited, after three years the rate of relapses was comparable between those who had a pregnancy after undergoing hormonal stimulation and assisted fertilization techniques and among those who had a natural pregnancy : 9.7% versus 8.7%, respectively. “These data – concludes Carlos Arteaga, co-director of the congress and director of the Simmons Comprehensive Cancer Center in Dallas – are reassuring for young patients diagnosed with breast cancer and show that assisted reproductive techniques are a possibility probably safe, with the caveat that they require longer follow-up.”