Fertility Treatment Safe for Breast Cancer Survivors With BRCA Mutations

In young BRCA carriers who survived breast cancer, assisted reproductive techniques (ART) did not increase the risk of disease recurrence or adversely affect pregnancy outcomes, findings of an international cohort study suggested.

Among more than 500 women with a pregnancy after treatment for BRCA-mutant breast cancer, 13.1% of women who got pregnant using ART had a disease-free survival (DFS) event over a median follow-up of 5.2 years after conception, as compared with 27.1% of those who conceived naturally, a non-significant difference (P=0.147), according to Matteo Lambertini, MD, PhD, of the University of Genova-IRCCS Policlinico San Martino Hospital in Italy.

Women who conceived with ART did have a slightly higher rate of miscarriage compared with those who had no ART (11.3% vs 8.8%), but had a lower rate of induced abortion (0.9% vs 8.3%), although the differences between the two groups were again not statistically significant. More than 80% of pregnancies in each group were reported to have no pregnancy complications, Lambertini reported at the European Society for Medical Oncology Breast Cancer Congress in Berlin.

“Using ART in order to achieve a pregnancy did not appear to negatively influence maternal prognosis or pregnancy outcomes, so it can be considered safe,” said Lambertini during his presentation. “Given the interest in having their own family, and for some of them in avoiding the transmission of the BRCA pathogenic variant by the use of preimplantation genetic testing, our results are critical to improve the oncofertility counseling of young women with breast cancer.”

While increasing evidence has demonstrated the safety of ART before or after anticancer treatments in women with breast cancer, “very limited evidence exists on ART use and safety among BRCA carriers with breast cancer,” Lambertini said in explaining the rationale behind the study.

ESMO discussant Janice Tsang, MBBS, of the University of Hong Kong, said the study “provides additional real-world data and real-world evidence to support more comprehensive oncofertility counseling for young BRCA carriers with breast cancer,” and added that fertility preservation at the time of diagnosis of early breast cancer should be offered to BRCA carriers.

In surveys of young women with breast cancer, more than half reported substantial concerns about fertility issues, Tsang noted, and about one-third reported that fertility concerns influenced treatment.

Thus, she asked if healthcare providers are ready — and have the skill set — to deal with these concerns, “and are our patients ready psychologically, as well?”

In addition, since nulliparity is a known risk factor for breast cancer, she also asked whether, with the results from this study, physicians should “include or incorporate fertility planning and preservation for all our young patients, including BRCA carrier patients?”

Lambertini presented data from an international, multicenter, hospital-based, retrospective cohort study that was conducted at 78 participating centers worldwide and included 4,732 BRCA carriers, 659 of whom had at least one pregnancy after breast cancer. Of those, 543 were included in this analysis — 107 in the ART group and 436 in the no-ART group.

In the ART group, 45.5% underwent ART at diagnosis, 33.3% had ART after anticancer treatments, and 21.2% underwent oocyte donation. Lambertini and colleagues also performed an exploratory analysis according to ART type — at diagnosis, after anticancer treatments, and oocyte donation — and found no difference in DFS between them.

Compared with the no-ART group, patients in the ART group were significantly older at the time of conception (37.1 vs 34.3 years), had more hormone receptor-positive breast cancer (43.4% vs 30.8%), and had a longer median time from diagnosis to conception (4.2 vs 3.3 years).

Overall, 83% of patients in the ART group delivered a child versus 79.8% of those in the no-ART group. Of those, pregnancies were without complications in 81.6% and 87%, respectively. Preterm births occurred in 14.5% of ART pregnancies and 8.5% of no-ART pregnancies.

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