Pregnancy after breast cancer: latest evidence and practical considerations

Advancements in breast cancer care have significantly improved survival rates in women of all ages; however, young survivors face unique challenges related to fertility, pregnancy, and maternal-fetal health which may impact on their medical and psychosocial outcomes. Increasingly, young women are diagnosed with breast cancer before completing their reproductive plans and goals and may undergo gonadotoxic therapies and prolonged endocrine therapy with age-related fertility decline. Pretreatment counseling is critical to manage expectations, align reproductive and treatment goals, plan future childbearing opportunities, and refer for fertility preservation interventions when needed. Evidence supports the safety of pregnancy and breastfeeding in posttreatment scenarios, with individual risks and treatment histories carefully evaluated. The growing use of novel agents like CDK4/6 inhibitors, poly-ADP-ribose polymerase inhibitors, and immune checkpoint inhibitors for which there are little to no data regarding impact on fertility highlights the urgent need for further research in this area. Patient-centered, multidisciplinary approaches applied throughout the disease trajectory remain essential to support the reproductive health and overall quality of life of young breast cancer survivors navigating the reproductive complexities of modern breast cancer treatment.