Pregnancy after breast cancer: hope after the storm

Over the last few decades, long-term outcomes of young women with breast cancer have greatly improved, raising several new survivorship needs which include fertility preservation and pregnancy. The prejudice against pregnancy after breast cancer is still alive among different healthcare providers (e.g. gynecologists, oncologists, general practitioners) and women are often confused and left alone in their family decision planning. All the available retrospective data confirm pregnancy after breast cancer is safe both for the mother and the offspring, also in women with hormone receptor positive disease. Timing of conception after the disease is still a matter of debate, especially in women receiving adjuvant endocrine therapy. A worldwide prospective trial is currently assessing safety of interrupting endocrine treatment to allow conception. Breastfeeding after breast cancer local therapy (surgery and radiation therapy) can be challenging but should not be discouraged. Patients harboring pathogenic mutations in breast cancer predisposing genes represent a small but growing population facing specific problems, such as, among others, prophylactic breast and ovarian surgery, and preimplantation genetic assessment, which all deserve a dedicated and sensitive approach. This review will highlight and summarize the current evidence and the research perspectives of pregnancy after breast cancer, to provide healthcare professionals the information they need to properly counsel young women with breast cancer who desire to conceive.