Approximately one in every 210 women will be diagnosed with breast cancer before the age of 40. Consequently, in the United States alone, more than 250,000 women under 40 have a history of breast cancer, and more than 10,000 additional young women are diagnosed annually. Many of these young survivors, and some older women, are interested in having a biologic child after breast cancer. Because nulliparity and late first pregnancy increase risk for breast cancer, a disproportionate number of young breast cancer patients may desire a future pregnancy at diagnosis compared to survivors of other adult malignancies. While breast cancer treatments including chemotherapy and hormonal therapy may result in ovarian dysfunction and associated infertility, many young breast cancer survivors remain premenopausal after therapy is complete. Studies suggest that 5-15% of young women with breast cancer will later become pregnant. However, patients, loved ones, and physicians may struggle with the idea of childbearing in the setting of potential disease recurrence as well as the theoretical concern that subsequent pregnancy may increase this risk. Hypothetically, residual breast cancer cells, if present, could be stimulated by reproductive hormones, particularly in women with a history of a hormone receptor-positive breast cancer, in whom antiestrogen therapy improves survival. Given these concerns, familiarity with current information regarding pregnancy after breast cancer, and the limitations of the available data, may help physicians to counsel young breast cancer survivors about their cancer and their reproductive health issues.
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