Partridge Ann H, Ruddy Kathryn J
Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, 44 Binney Street, D1210 Boston, MA 02115, USA.
Breast. 2007 Dec;16 Suppl 2:S175-81. doi: 10.1016/j.breast.2007.07.029. Epub 2007 Sep 4.
Women of childbearing age with breast cancer are often concerned about whether they will become infertile after treatment, and for those who wish to bear children, whether a subsequent pregnancy will alter their risk of disease recurrence. The risk of chemotherapy-related amenorrhea (CRA), menopause, and infertility appear to be related to patient age and type of treatment received, though data regarding actual fertility following treatment are limited. There are options available for fertility preservation for young women who wish to have a biologic child after breast cancer and are at risk for infertility. Options include cryopreservation of embryos, oocytes, ovarian tissue prior to treatment, and ovarian suppression through chemotherapy. However, most of these are considered experimental, and there are limited data regarding the safety of such strategies. There has been concern that pregnancy after breast cancer may worsen prognosis in light of the endocrine manipulations used to treat breast cancer, particularly for women with hormone sensitive disease. Several studies addressing the potential risk of pregnancy after breast cancer have not revealed any negative effect on prognosis. However, these studies have significant limitations, and concerns about a negative impact for some remain. Ongoing and future prospective studies evaluating fertility and pregnancy issues for young breast cancer survivors are warranted for this vulnerable population facing this difficult issue.
育龄期乳腺癌女性常常担心治疗后是否会不孕，而对于那些希望生育的女性来说，后续怀孕是否会改变疾病复发风险。化疗相关闭经（CRA）、绝经和不孕的风险似乎与患者年龄及所接受的治疗类型有关，不过关于治疗后实际生育能力的数据有限。对于那些希望在患乳腺癌后生育亲生孩子且有不孕风险的年轻女性，有一些生育力保存的选择。这些选择包括在治疗前冷冻胚胎、卵母细胞、卵巢组织，以及通过化疗进行卵巢抑制。然而，其中大多数被认为是试验性的，关于这些策略安全性的数据也很有限。鉴于用于治疗乳腺癌的内分泌干预措施，尤其是对于激素敏感型疾病的女性，有人担心乳腺癌后怀孕可能会使预后恶化。几项针对乳腺癌后怀孕潜在风险的研究并未发现对预后有任何负面影响。然而，这些研究有显著局限性，对一些负面影响的担忧仍然存在。对于面临这一难题的脆弱人群，有必要开展正在进行的和未来的前瞻性研究，以评估年轻乳腺癌幸存者的生育能力和怀孕问题。
