Sorouri Kimia, Sella Tal, Rosenberg Shoshana M, Loucks Maggie, Kirkner Gregory, Snow Craig, Ruddy Kathryn J, Gelber Shari I, Tamimi Rulla M, Peppercorn Jeffrey M, Schapira Lidia, Borges Virginia F, Come Steven E, Warner Ellen, Partridge Ann H
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts, USA.
Cancer. 2024 Feb 15;130(4):517-529. doi: 10.1002/cncr.35066. Epub 2023 Oct 25.
Breast cancer (BC) is the most common malignancy in women of reproductive age. This study sought to explore the postcancer conception and pregnancy experience of young BC survivors to inform counseling.
In the Young Women's Breast Cancer Study (NCT01468246), a multicenter, prospective cohort, participants diagnosed at age ≤40 years with stage 0-III BC who reported ≥1 postdiagnosis live birth were sent an investigator-developed survey.
Of 119 eligible women, 94 (79%) completed the survey. Median age at diagnosis was 32 years (range, 17-40) and at first postdiagnosis delivery was 38 years (range, 29-47). Most had stage I or II (77%) and HR+ (78%) BC; 51% were nulligravida at diagnosis. After BC treatment, most (62%) conceived naturally, though 38% used assisted reproductive technology, 74% of whom first attempted natural conception for a median of 9 months (range, 2-48). Among women with a known inherited pathogenic variant (n = 20), two underwent preimplantation genetic testing. Of 59 women on endocrine therapy before pregnancy, 26% did not resume treatment. Hypertensive disorders of pregnancy (20%) was the most common obstetrical condition. Nine percent of newborns required neonatal intensive care unit admission and 9% had low birth weight.
Among women with live births after BC treatment, most conceived naturally and having a history of BC did not appear to negatively impact pregnancy complications, though the high rate of hypertensive disorders of pregnancy warrants further investigation. The prolonged period of attempting natural conception for some survivors suggests the potential need for improved understanding and counseling surrounding family planning goals after BC.
乳腺癌（BC）是育龄女性中最常见的恶性肿瘤。本研究旨在探讨年轻乳腺癌幸存者癌症后的受孕和妊娠经历，为咨询提供依据。
在“年轻女性乳腺癌研究”（NCT01468246）中，这是一项多中心前瞻性队列研究，对年龄≤40岁、诊断为0-III期乳腺癌且报告有≥1次诊断后活产的参与者发送了研究者编制的调查问卷。
119名符合条件的女性中，94名（79%）完成了调查。诊断时的中位年龄为32岁（范围17-40岁），诊断后首次分娩时的中位年龄为38岁（范围29-47岁）。大多数患有I期或II期（77%）和激素受体阳性（HR+，78%）乳腺癌；51%在诊断时为未孕。乳腺癌治疗后，大多数（62%）自然受孕，尽管38%使用了辅助生殖技术，其中74%首先尝试自然受孕，中位时间为9个月（范围2-48个月）。在已知有遗传性致病变异的女性（n = 20）中，两名接受了植入前基因检测。在妊娠前接受内分泌治疗的59名女性中，26%未恢复治疗。妊娠期高血压疾病（20%）是最常见的产科情况。9%的新生儿需要入住新生儿重症监护病房，9%出生体重低。
在乳腺癌治疗后有活产的女性中，大多数自然受孕，且有乳腺癌病史似乎并未对妊娠并发症产生负面影响，尽管妊娠期高血压疾病的高发生率值得进一步研究。一些幸存者尝试自然受孕的时间较长，这表明可能需要更好地理解和围绕乳腺癌后的计划生育目标进行咨询。
