• Introduction
  
• Impact on Post Pregnancy Outcome
• Conception and Delivery Post Treatment
  
• Conclusion
  
  
  
  

Is there a negative impact of a post treatment pregnancy on breast cancer outcome ?: Less than 10% of women who have been treated for breast cancer will desire a future pregnancy. Therefore, the amount of data that is available to answer this question is relatively small. Appreciating this limitation, the extant data has demonstrated that, after adjusting for age, stage of disease, and reproductive history prior to breast cancer treatment, women who have a post therapy full term pregnancy have no significant difference in their cancer-outcome than do women who do not become pregnant . This reality is not fully appreciated by many clinicians. An important consideration, however, is what difference would if make to the woman if she knew that her cancer was going to return? Would she opt not to become pregnanct, choosing to avoid bringing a child into the World, a child that has a high chance of loosing its biologic mother ? Or would the patient chose to reproduce so that a legacy could be established ? These are all difficult questions, the answers to which are highly personal. Many medical oncologists will attempt to minimize the necessity to even answer these questions by encouraging women to delay child bearing for about 2 years after the completion of the first treatment for breast cancer. The rationale for this tact is based upon the realization that the majority of young women who do develop recurrent breast cancer will do such within the first two years. By delaying reproduction beyond this time window, the probability that a patient is going to have to make these difficult decisions is decreased, though not eliminated.

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Will the treatment I have had negatively effect my ability to conceive and successfully deliver a baby ?This question is more difficult to answer, with the response being a product of the reproductive age of the patient, her prior pregnancy history, and the treatment administered. Women who do not receive systemic (i.e. chemotherapy) treatment, really do not have to be concerned regarding any possible negative effect on either fertility or fecundity. Women who are earlier in their reproductive life and receive short course chemotherapy are less likely to experience a negative effect on fertility. In contradistinction, women that are closer to the menopause and have received higher doses of chemotherapuetic agents, particularily if the agents are alkylating agents that were given for long time periods, may have as much as a 50% chance of becoming anovulatory . However, should the patient become pregnant, the probability that she will successful carry a genetically normal fetus to term is approximately the same as aged matched women who had not received chemotherapy 3.

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CONCLUSION: Fortunately, the majority of women who will ask the questions summarized above will receive answers that are positive and re-assuring. Even those women who do develop ovarian failure as an end result of chemotherapy treatment of breast cancer have numerous options available to them in the modern era of assisted reproductive technology (i.e., oocyte donation, surrogacy, etc.)

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References:

1. Kroman N, Wohlfahrt J, Andersen KW, et al. Time since childbirth and prognosis in primary breast cancer; population based study. BMJ 1997;315:851-855.
2. Von Schoultz E, Johansson H, Wilking N, et al. Influence of prior and subsequent pregnancy on breast cancer prognosis. J Clin Oncol 1995;13:430-434.
3. Holschneider HC, Montz FJ. Radiation and chemotherapy and the effects on the menstrual cycle and reproduction. Infert and Reprod Med Clinics N Amer 1998;9:739-767.

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