Childbearing issues in breast carcinoma survivors

The issue of the subsequent pregnancy after breast carcinoma treatment is of paramount importance to young survivors and their oncologists. Matters related to having children, whether biologic or not, are analyzed.

Available evidence on the role of estrogen in the carcinogenesis and promotion of breast carcinoma is summarized. The scanty literature on pregnancy in breast carcinoma survivors is reviewed and evaluated. With reference to infertility as the result of adjuvant treatment, studies on therapy-induced amenorrhea are cited.

The survival of women with breast carcinoma is not decreased by subsequent pregnancy in any of the published series. Nevertheless, several biases may be present, making the results less than conclusive; no prospective studies exist. Theoretic concern of tumor promotion may be justified when considering the long term exposure to intense gestational hormones in the presence of established breast carcinoma with possible micrometastases. As a separate issue, the common situation of chemotherapy-induced amenorrhea may not permit pregnancy. Information for the breast carcinoma survivor on assisted conception and adoption is limited.

Further research on the safety of subsequent pregnancy after breast carcinoma treatment is needed; the authors report that they are initiating a multicenter prospective study to address these issues.