Department of Medical Oncology, Jules Bordet Institute, Boulevard de Waterloo 121, 1000 Brussels, Belgium.
Expert Rev Anticancer Ther. 2011 Feb;11(2):287-98. doi: 10.1586/era.10.208.
Advances in the field of adjuvant therapy in breast cancer have led to significant improvements in breast cancer survival. This has resulted in a progressive decline in breast cancer-related mortality, such that in 2010 there were estimated to be 400,000 breast cancer survivors under the age of 40 in the USA. Hence, enquiry into the feasibility of fertility preservation, subsequent pregnancy and breastfeeding is increasingly encountered. Fertility counseling remains suboptimal in breast cancer clinics, and there is a wide perception that pregnancy could worsen the prognosis of young breast cancer survivors, despite the lack of evidence supporting this notion. In addition, fertility preservation by means of embryo or oocyte cryopreservation requires ovarian stimulation, which is associated with a significant rise in estradiol levels and might delay initiation of therapy. All these factors, and others, have influenced the quality of fertility counseling offered to young breast cancer patients. In this article, we will critically analyze the available clinical and biological evidence on the safety and feasibility of pregnancy and breastfeeding following breast cancer. In addition, we will discuss the different fertility-preservation techniques available for these patients.
乳腺癌辅助治疗领域的进展使乳腺癌患者的生存率显著提高。这导致乳腺癌相关死亡率呈渐进式下降，以至于 2010 年据估计在美国有 40 万名 40 岁以下的乳腺癌幸存者。因此，人们越来越多地探讨生育力保存、后续妊娠和哺乳的可行性。乳腺癌临床科室中的生育咨询仍然不尽如人意，人们普遍认为怀孕可能会使年轻乳腺癌幸存者的预后恶化，尽管缺乏支持这一观点的证据。此外，通过胚胎或卵母细胞冷冻保存进行生育力保存需要卵巢刺激，这会导致雌二醇水平显著升高，并可能延迟治疗的开始。所有这些因素以及其他因素都影响了向年轻乳腺癌患者提供的生育咨询质量。在本文中，我们将批判性地分析现有关于乳腺癌患者妊娠和哺乳的安全性和可行性的临床和生物学证据。此外，我们还将讨论为这些患者提供的不同生育力保存技术。
