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Pregnancy After Breast Cancer in Young BRCA Carriers: An International Hospital-Based Cohort Study
Ist Teil von
JAMA : the journal of the American Medical Association, 2024-01, Vol.331 (1), p.49
Erscheinungsjahr
2024
Beschreibungen/Notizen
Importance
Young women with breast cancer who have germline pathogenic variants in
BRCA1
or
BRCA2
face unique challenges regarding fertility. Previous studies demonstrating the feasibility and safety of pregnancy in breast cancer survivors included limited data regarding
BRCA
carriers.
Objective
To investigate cumulative incidence of pregnancy and disease-free survival in young women who are
BRCA
carriers.
Design, Setting, and Participants
International, multicenter, hospital-based, retrospective cohort study conducted at 78 participating centers worldwide. The study included female participants diagnosed with invasive breast cancer at age 40 years or younger between January 2000 and December 2020 carrying germline pathogenic variants in
BRCA1
and/or
BRCA2
. Last delivery was October 7, 2022; last follow-up was February 20, 2023.
Exposure
Pregnancy after breast cancer.
Main Outcomes and Measures
Primary end points were cumulative incidence of pregnancy after breast cancer and disease-free survival. Secondary end points were breast cancer–specific survival, overall survival, pregnancy, and fetal and obstetric outcomes.
Results
Of 4732
BRCA
carriers included, 659 had at least 1 pregnancy after breast cancer and 4073 did not. Median age at diagnosis in the overall cohort was 35 years (IQR, 31-38 years). Cumulative incidence of pregnancy at 10 years was 22% (95% CI, 21%-24%), with a median time from breast cancer diagnosis to conception of 3.5 years (IQR, 2.2-5.3 years). Among the 659 patients who had a pregnancy, 45 (6.9%) and 63 (9.7%) had an induced abortion or a miscarriage, respectively. Of the 517 patients (79.7%) with a completed pregnancy, 406 (91.0%) delivered at term (≥37 weeks) and 54 (10.4%) had twins. Among the 470 infants born with known information on pregnancy complications, 4 (0.9%) had documented congenital anomalies. Median follow-up was 7.8 years (IQR, 4.5-12.6 years). No significant difference in disease-free survival was observed between patients with or without a pregnancy after breast cancer (adjusted hazard ratio, 0.99; 95% CI, 0.81-1.20). Patients who had a pregnancy had significantly better breast cancer–specific survival and overall survival.
Conclusions and Relevance
In this global study, 1 in 5 young
BRCA
carriers conceived within 10 years after breast cancer diagnosis. Pregnancy following breast cancer in
BRCA
carriers was not associated with decreased disease-free survival.
Trial Registration
ClinicalTrials.gov Identifier:
NCT03673306