Mom after breast cancer (also discovered during pregnancy)? One more chance to become one – breaking latest news

Becoming a mother despite being diagnosed with breast cancer possible, both for those who are treated first and then would like to complete the project of a family, and for those who discover the neoplasm by chance during the months of gestation. Thanks to the progress made in recent years by scientific research (and in particular by Italian research, which has carried out studies and developed techniques now used all over the world on fertility preservation), young women who receive a cancer diagnosis before the age of 40 years old and would like to have children have several strategies available to safeguard reproductive function from the side effects of anticancer therapies. Not only. A recent study, which had the substantial contribution of Italian researchers, has just opened up a new option: stop hormone therapy for two years (very often prescribed for 5-10 years, after surgery, to reduce the risk of recurrence) and thus give the patient time to try to become pregnant. Furthermore, even in the very rare cases in which cancer is diagnosed in a woman who is already pregnant, doctors know the procedure to follow: having to save the child or the mother is now an increasingly less obligatory choice.

Rare events

however, it is essential that women are informed and that they turn to hospitals that have experience on this front. Every year around three thousand (out of 55,700 new cases estimated in 2022) are young Italians who receive a diagnosis of breast cancer before the age of 40 and only 5 out of 100 then become mothers after the disease. Discovering the neoplasm when you are already pregnant is an even rarer possibility: it happens in 1 pregnancy out of 1000, in all about 150 cases per year in our country. In 80% of cases, breast cancer strikes after the age of 50, but the incidence in 30-40 year olds is growing and the desire to become mothers after the disease continues to be underestimated.

The new research

The low percentage of young patients who manage to have a child after cancer contrasts sharply with the 50% of women who, at the time of diagnosis, declare that they want a motherhood – says Lucia Del Mastro, full professor and director of Oncology at the Irccs San Martino Polyclinic Hospital, University of Genoa, author, with her group, of the researches then adopted in clinical practice all over the world -. Why? Surely there is the fact that, before the POSITIVE study (presented at the last San Antonio Breast Cancer Symposium in Texas) women with hormone-responsive cancer had to wait at least five years before trying to get pregnant, thus going towards a younger age mature. This study demonstrates that after at least a year and a half of therapy, it is possible to suspend hormonal treatment for two years with the aim of having a child (naturally or with assisted fertilization techniques), and then resume treatment: in doing so increases the risk of a relapse. The study involved 518 women under 42 with hormone receptor-positive early breast cancer: in these cases hormone therapy is administered, post surgery, to reduce the risk of the disease coming back. 74% of women had at least one pregnancy, which ended successfully in 64% of cases; congenital anomalies were observed in 2% of the children, similar to the general population, and 60% of the mothers breastfed.

How to preserve fertility

If until a few years ago the only solution to have children was freeze the eggs before the therapy to then proceed, once healed, to in vitro fertilization, again in Genoa in 2011 one of the three main fertility preservation techniques was defined: it is possible protect ovarian function from the toxic effects of chemotherapy by administering to patients drugs (hormone analogues of Lh-Rh) which put the ovaries at rest during treatments, so that they are not damaged – explains Matteo Lambertini, associate professor of medical oncology at the University of Genoa – Irccs San Martino Hospital -. The other techniques consist of the cryopreservation, i.e. from freezing, either of the oocytes or of the ovarian tissue. Time is a precious ally: Timing is decisive, both for treating the tumor and for preserving fertility: the cryopreservation of oocytes must take place before the start of chemotherapy, underlines Del Mastro. It is therefore necessary to create specific paths: in Genoa, for example, the patient sees both the oncology specialist and the fertility preservation specialist on the same day (or at the latest the day after).

Doing chemo while pregnant

important to know that today patients can be treated effectively, the therapies we prescribe do not harm the health of children and it is not always mandatory to terminate the pregnancy to take care of the mother – clarifies Fedro Peccatori, director of the Fertility and Procreation Unit in Oncology at the European Institute of Oncology (IEO) in Milan, -. Numerous studies have found that once the first three months of gestation are over, chemotherapy can be done safely (safe for the baby and for the mother). And if for radiotherapy you have to wait after childbirth, access to the operating room has no limits: the patient can generally undergo surgery (also under general anesthesia, if necessary) even in the first 13 weeks. There are now a thousand children in the world born in these circumstances: children, even adolescents, are healthy because oncological treatments have not caused them harm.

Healthy babies

According to statistics, children born to mothers treated with chemotherapy who tried to become pregnant at the end of treatment are at increased risk of being born underweight, being born preterm, and being born by caesarean section. Reason why – says Matteo Lambertini – it is good that pregnant women are followed with particular attention. However, there are no significant additional dangers of congenital malformations or complications during pregnancy or on the health of the mothers. Another chapter: babies born to mothers who received chemo during pregnancy. We have substantial information on children and adolescents who have been followed up internationally for many years: they are healthy – says Fedro Peccatori -. No problems have emerged, nor neurological damage, although the brain is the most plastic organ, the one that undergoes the greatest changes during the second and third trimester of pregnancy. It is certainly important to be followed by reference centers, because treating cancer in a pregnant woman is still a delicate situation.