Pregnancy is not contraindicated in pathogenic BRCA carriers

More than 1 in 5 young women who are pathogenic BRCA carriers became pregnant after a diagnosis of early breast cancer. Their disease-free survival after pregnancy was comparable with those who did not become pregnant, as was shown by results of an international study.

A substantial proportion of young women with newly diagnosed breast cancer are interested in future fertility [1]. More than 12% of these young patients carry a germline pathogenic variant in the BRCA1 or BRCA2 genes [2]. Reproductive counselling of pathogenic BRCA carriers is complex, considering the psychological fear of transmitting the genetic variant to their offspring, the possible negative impact of deficient BRCA function on fertility potential, and the indication to undergo risk-reducing bilateral salpingo-oophorectomy at a young age. In addition, while several studies have demonstrated the safety of conceiving following breast cancer diagnosis and treatment, the evidence in pathogenic BRCA carriers is limited [3].

An international, multicentre, hospital-based, retrospective cohort study including young women with history of breast cancer and a pathogenic BRCA variant (NCT03673306) aimed to provide more solid evidence in the field. The study enrolled 4,732 patients, aged 40 years or younger, who were diagnosed with BRCA1- or BRCA2-mutated, stage I–III, invasive breast cancer. The primary endpoints were cumulative incidence of pregnancy after breast cancer and disease-free survival. Secondary endpoints were breast cancer-specific survival, overall survival, pregnancy, and foetal and obstetric outcomes. Dr Matteo Lambertini (University of Genova, Italy) presented the results [4].

After a median follow-up of 7.8 years, 659 of the participating women had at least 1 pregnancy, and 4,073 had no pregnancy. 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). In patients with HR-positive disease, cumulative incidence of pregnancy at 10 years was lower (18% vs 26%) and median time to pregnancy was longer (4.3 vs 3.2 years), compared with patients with HR-negative disease. Rates of pregnancy and foetal and obstetric complications were in line with the expectations in a population of women with similar age and no history of breast cancer.

Of note, no significant difference in disease-free survival was observed between women with or without a pregnancy after breast cancer (adjusted HR 0.99; 95% CI 0.81–1.20). The occurrence of pregnancy was associated with a lower rate of breast cancer-specific survival events (adjusted HR 0.60; 95% CI 0.40–0.88; P=0.009).

Dr Lambertini concluded that “this study showed that more than 1 in 5 young women who are pathogenic BRCA carriers became pregnant after a diagnosis of early breast cancer and that disease-free survival was comparable with those who did not become pregnant. Therefore, conceiving after proper treatment and follow-up for breast cancer should not be contraindicated in these women.”

1. Ruddy KJ, et al. J Clin Oncol. 2014;32:1151-1156.
2. Copson ER, et al. Lancet Oncol. 2018;19:169-180.
3. Lambertini M, et al. J Clin Oncol. 2021;39:3293-3305.
4. Lambertini M, et al. Pregnancy after breast cancer in young women with germline BRCA pathogenic variants: results from an international cohort study. Abstract GS02-13, SABCS 2023, 5-9 December, San Antonio, TX, USA.

 

Copyright ©2024 Medicom Medical Publishers



Posted on 11 January, 202411 January, 2024