TY - JOUR
T1 - Pregnancy after Breast Cancer in Young BRCA Carriers
T2 - An International Hospital-Based Cohort Study
AU - Lambertini, Matteo
AU - Blondeaux, Eva
AU - Agostinetto, Elisa
AU - Hamy, Anne Sophie
AU - Kim, Hee Jeong
AU - Di Meglio, Antonio
AU - Bernstein Molho, Rinat
AU - Hilbers, Florentine
AU - Pogoda, Katarzyna
AU - Carrasco, Estela
AU - Punie, Kevin
AU - Bajpai, Jyoti
AU - Ignatiadis, Michail
AU - Moore, Halle C.F.
AU - Phillips, Kelly Anne
AU - Toss, Angela
AU - Rousset-Jablonski, Christine
AU - Peccatori, Fedro A.
AU - Renaud, Tiphaine
AU - Ferrari, Alberta
AU - Paluch-Shimon, Shani
AU - Fruscio, Robert
AU - Cui, Wanda
AU - Wong, Stephanie M.
AU - Vernieri, Claudio
AU - Ruddy, Kathryn J.
AU - Dieci, Maria Vittoria
AU - Matikas, Alexios
AU - Rozenblit, Mariya
AU - Villarreal-Garza, Cynthia
AU - De Marchis, Laura
AU - Del Mastro, Lucia
AU - Puglisi, Fabio
AU - Del Pilar Estevez-Diz, Maria
AU - Rodriguez-Wallberg, Kenny A.
AU - Mrinakova, Bela
AU - Meister, Sarah
AU - Livraghi, Luca
AU - Clatot, Florian
AU - Yerushalmi, Rinat
AU - De Angelis, Carmine
AU - Sánchez-Bayona, Rodrigo
AU - Meattini, Icro
AU - Cichowska-Cwalińska, Natalia
AU - Berlière, Martine
AU - Salama, Mahmoud
AU - De Giorgi, Ugo
AU - Sonnenblick, Amir
AU - Chiodi, Camila
AU - Lee, Young Jin
AU - Maria, Camille
AU - Azim, Hatem A.
AU - Boni, Luca
AU - Partridge, Ann H.
N1 - Publisher Copyright:
© 2024 American Medical Association. All rights reserved.
PY - 2024/1/2
Y1 - 2024/1/2
N2 - Importance: Young women with breast cancer who have germline pathogenic variants in BRCA1 or BRCA2 face unique challenges regarding fertility. Previous studies demonstrating the feasibility and safety of pregnancy in breast cancer survivors included limited data regarding BRCA carriers. Objective: To investigate cumulative incidence of pregnancy and disease-free survival in young women who are BRCA carriers. Design, Setting, and Participants: International, multicenter, hospital-based, retrospective cohort study conducted at 78 participating centers worldwide. The study included female participants diagnosed with invasive breast cancer at age 40 years or younger between January 2000 and December 2020 carrying germline pathogenic variants in BRCA1 and/or BRCA2. Last delivery was October 7, 2022; last follow-up was February 20, 2023. Exposure: Pregnancy after breast cancer. Main Outcomes and Measures: Primary end points were cumulative incidence of pregnancy after breast cancer and disease-free survival. Secondary end points were breast cancer-specific survival, overall survival, pregnancy, and fetal and obstetric outcomes. Results: Of 4732 BRCA carriers included, 659 had at least 1 pregnancy after breast cancer and 4073 did not. Median age at diagnosis in the overall cohort was 35 years (IQR, 31-38 years). Cumulative incidence of pregnancy at 10 years was 22% (95% CI, 21%-24%), with a median time from breast cancer diagnosis to conception of 3.5 years (IQR, 2.2-5.3 years). Among the 659 patients who had a pregnancy, 45 (6.9%) and 63 (9.7%) had an induced abortion or a miscarriage, respectively. Of the 517 patients (79.7%) with a completed pregnancy, 406 (91.0%) delivered at term (≥37 weeks) and 54 (10.4%) had twins. Among the 470 infants born with known information on pregnancy complications, 4 (0.9%) had documented congenital anomalies. Median follow-up was 7.8 years (IQR, 4.5-12.6 years). No significant difference in disease-free survival was observed between patients with or without a pregnancy after breast cancer (adjusted hazard ratio, 0.99; 95% CI, 0.81-1.20). Patients who had a pregnancy had significantly better breast cancer-specific survival and overall survival. Conclusions and Relevance: In this global study, 1 in 5 young BRCA carriers conceived within 10 years after breast cancer diagnosis. Pregnancy following breast cancer in BRCA carriers was not associated with decreased disease-free survival. Trial Registration: ClinicalTrials.gov Identifier: NCT03673306.
AB - Importance: Young women with breast cancer who have germline pathogenic variants in BRCA1 or BRCA2 face unique challenges regarding fertility. Previous studies demonstrating the feasibility and safety of pregnancy in breast cancer survivors included limited data regarding BRCA carriers. Objective: To investigate cumulative incidence of pregnancy and disease-free survival in young women who are BRCA carriers. Design, Setting, and Participants: International, multicenter, hospital-based, retrospective cohort study conducted at 78 participating centers worldwide. The study included female participants diagnosed with invasive breast cancer at age 40 years or younger between January 2000 and December 2020 carrying germline pathogenic variants in BRCA1 and/or BRCA2. Last delivery was October 7, 2022; last follow-up was February 20, 2023. Exposure: Pregnancy after breast cancer. Main Outcomes and Measures: Primary end points were cumulative incidence of pregnancy after breast cancer and disease-free survival. Secondary end points were breast cancer-specific survival, overall survival, pregnancy, and fetal and obstetric outcomes. Results: Of 4732 BRCA carriers included, 659 had at least 1 pregnancy after breast cancer and 4073 did not. Median age at diagnosis in the overall cohort was 35 years (IQR, 31-38 years). Cumulative incidence of pregnancy at 10 years was 22% (95% CI, 21%-24%), with a median time from breast cancer diagnosis to conception of 3.5 years (IQR, 2.2-5.3 years). Among the 659 patients who had a pregnancy, 45 (6.9%) and 63 (9.7%) had an induced abortion or a miscarriage, respectively. Of the 517 patients (79.7%) with a completed pregnancy, 406 (91.0%) delivered at term (≥37 weeks) and 54 (10.4%) had twins. Among the 470 infants born with known information on pregnancy complications, 4 (0.9%) had documented congenital anomalies. Median follow-up was 7.8 years (IQR, 4.5-12.6 years). No significant difference in disease-free survival was observed between patients with or without a pregnancy after breast cancer (adjusted hazard ratio, 0.99; 95% CI, 0.81-1.20). Patients who had a pregnancy had significantly better breast cancer-specific survival and overall survival. Conclusions and Relevance: In this global study, 1 in 5 young BRCA carriers conceived within 10 years after breast cancer diagnosis. Pregnancy following breast cancer in BRCA carriers was not associated with decreased disease-free survival. Trial Registration: ClinicalTrials.gov Identifier: NCT03673306.
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U2 - 10.1001/jama.2023.25463
DO - 10.1001/jama.2023.25463
M3 - Article
C2 - 38059899
AN - SCOPUS:85180936279
SN - 0098-7484
VL - 331
SP - 49
EP - 59
JO - JAMA
JF - JAMA
IS - 1
ER -