Pregnancy After Breast Cancer in Young <i>BRCA </i>Carriers-Reference-Cited by-同舟云学术

Pregnancy After Breast Cancer in Young BRCA Carriers

Published:2024-01-02 Issue:1 Volume:331 Page:49
ISSN:0098-7484
Container-title:JAMA
language:en
Short-container-title:JAMA

Author:

Lambertini Matteo¹²,Blondeaux Eva³,Agostinetto Elisa⁴,Hamy Anne-Sophie⁵,Kim Hee Jeong⁶,Di Meglio Antonio⁷,Bernstein Molho Rinat⁸,Hilbers Florentine⁹,Pogoda Katarzyna¹⁰,Carrasco Estela¹¹,Punie Kevin¹²,Bajpai Jyoti¹³,Ignatiadis Michail⁴,Moore Halle C. F.¹⁴,Phillips Kelly-Anne¹⁵¹⁶¹⁷,Toss Angela¹⁸¹⁹,Rousset-Jablonski Christine²⁰,Peccatori Fedro A.²¹,Renaud Tiphaine²²,Ferrari Alberta²³,Paluch-Shimon Shani²⁴,Fruscio Robert²⁵,Cui Wanda¹⁵¹⁶,Wong Stephanie M.²⁶,Vernieri Claudio²⁷²⁸,Ruddy Kathryn J.²⁹,Dieci Maria Vittoria³⁰³¹,Matikas Alexios³²,Rozenblit Mariya³³,Villarreal-Garza Cynthia³⁴,De Marchis Laura³⁵³⁶,Del Mastro Lucia¹²,Puglisi Fabio³⁷³⁸,Del Pilar Estevez-Diz Maria³⁹,Rodriguez-Wallberg Kenny A.⁴⁰⁴¹,Mrinakova Bela⁴²,Meister Sarah⁴³,Livraghi Luca⁴⁴⁴⁵,Clatot Florian⁴⁶,Yerushalmi Rinat⁴⁷,De Angelis Carmine⁴⁸,Sánchez-Bayona Rodrigo⁴⁹,Meattini Icro⁵⁰,Cichowska-Cwalińska Natalia⁵¹⁵²,Berlière Martine⁵³,Salama Mahmoud⁵⁴,De Giorgi Ugo⁵⁵,Sonnenblick Amir⁵⁶,Chiodi Camila⁷,Lee Young-Jin⁶,Maria Camille⁵,Azim Hatem A.³⁴⁵⁷,Boni Luca³,Partridge Ann H.⁵⁸,de Azambuja Evandro⁵⁹,Molinelli Chiara⁵⁹,Paesmans Marianne⁵⁹,Ameye Lieveke⁵⁹,Amant Frédéric⁵⁹,Brems Hilde⁵⁹,Han Sileny⁵⁹,Hatse Sigrid⁵⁹,Nevelsteen Ines⁵⁹,Neven Patrick⁵⁹,Smeets Ann⁵⁹,Van Rompuy Chantal⁵⁹,Wildiers Hans⁵⁹,Duhoux Francois⁵⁹,Giugliano Federica⁵⁹,Criscitiello Carmen⁵⁹,Borea Roberto⁵⁹,Arecco Luca⁵⁹,Chirco Alessandra⁵⁹,Bini Federica⁵⁹,Venturelli Marta⁵⁹,Cortesi Laura⁵⁹,Ponzone Riccardo⁵⁹,Tomasi Cont Nicoletta⁵⁹,Balmaña Judith⁵⁹,Graffeo Rossella⁵⁹,Luna Pais Helena⁵⁹,Mohar Alejandro⁵⁹,Palacios Tamara⁵⁹,Da Ros Lucia⁵⁹,Miolo Gianmaria⁵⁹,Garutti Mattia⁵⁹,Pastò Brenno⁵⁹,Spazzapan Simon⁵⁹,Viel Alessandra⁵⁹,Pérez-Fidalgo Alejandro⁵⁹,Colombo Bonadio Renata⁵⁹,Peretz-Yablonski Tamar⁵⁹,Anghelone Chiara Annunziata Pasqualina⁵⁹,Della Valle Angelica⁵⁹,Campanella Maria⁵⁹,Guarneri Valentina⁵⁹,Bas Raphaelle⁵⁹,Heudel Pierre-Etienne⁵⁹,Tredan Olivier⁵⁹,de Talouet Solenne⁵⁹,Bonadona Valérie⁵⁹,Lasset Christine⁵⁹,Acheritogaray Marion⁵⁹,Senechal Claire⁵⁹,Mariño Monica⁵⁹,Córdoba Octavi⁵⁹,Feldman Didi⁵⁹,Pesce Romina I.⁵⁹,Allemand Carol⁵⁹,Riggi Cecilia⁵⁹,Iriarte Maria Belen⁵⁹,Cortés Salgado Alfonso⁵⁹,Cortes Javier⁵⁹,Gion María⁵⁹,Saavedra Cristina⁵⁹,Rodriguez Adela⁵⁹,Adamo Barbara⁵⁹,Prat Aleix⁵⁹,Hester Anna⁵⁹,Dunckelmann Sofia⁵⁹,Harbeck Nadia⁵⁹,Marhold Maximilian⁵⁹,Bartsch Rupert⁵⁹,Mannsbarth Constantin⁵⁹,Popovic Lazar⁵⁹,Božović-Spasojević Ivana⁵⁹,Krivokuca Ana⁵⁹,Dimitrijevic Marija⁵⁹,Visani Luca⁵⁹,Bettazzi Beatrice⁵⁹,Livi Lorenzo⁵⁹,Sposetti Caterina⁵⁹,Sini Valentina⁵⁹,Rognone Alessia⁵⁹,Bianchini Giampaolo⁵⁹,Patricelli Maria Grazia⁵⁹,Rabaiotti Emanuela⁵⁹,Gentilini Oreste⁵⁹,Fontana Andrea⁵⁹,Acconci Giulia⁵⁹,Baldacci Erica⁵⁹,Bianchini Giulia⁵⁹,Pistelli Mirco⁵⁹,Linn Sabine⁵⁹,Kleiterp Sieta⁵⁹,Moha Daoud A.⁵⁹,Sarin Rajiv⁵⁹,Sekar Anberson⁵⁹,Atzori Francesco⁵⁹,Loi Francesco⁵⁹,Dessì Mariele⁵⁹,O’Connor Sarah⁵⁹,Nesci Stephanie⁵⁹,James Paul⁵⁹,Michael Chris⁵⁹,Couch Fergus J.⁵⁹,Olson Janet E.⁵⁹,Larson Nicole L.⁵⁹,Yadav Siddhartha⁵⁹,Lopetegui Nerea⁵⁹,Carey Lisa A.⁵⁹,Abdou Yara⁵⁹,Zagami Paola⁵⁹,Di Rocco Roberta⁵⁹,Baldassarri Margherita⁵⁹,Bengala Carmelo⁵⁹,Mariamidze Elene⁵⁹,Graff Stephanie L.⁵⁹,Haddad Stephanie A.⁵⁹,Safran Emma⁵⁹,Vasconcelos de Matos Leonor⁵⁹,Ferreira Arlindo⁵⁹,Negri Serena⁵⁹,Dell'Oro Cristina⁵⁹,Inzoli Alessandra⁵⁹,Costa Clarissa⁵⁹,Marchetta Liliana⁵⁹,Lustberg Maryam⁵⁹,Blansky Deanna⁵⁹,Jeon June⁵⁹,Ansari Norin⁵⁹,Aguilar-y-Mendez Dione⁵⁹,Woodruff Teresa K.⁵⁹,Swain Monique⁵⁹,Miller Madison⁵⁹,Leach Richard⁵⁹,Fabi Alessandra⁵⁹,Palazzo Antonella⁵⁹,Paris Ida⁵⁹,Kufel-Grabowska Joanna⁵⁹,Synowiec Agnieszka⁵⁹,Hancinova Miriam⁵⁹,Tarbaj Lukas⁵⁹,Sokolović Emir⁵⁹,Bešlija Semir⁵⁹,Cerić Timur⁵⁹,Hasanbegović Berisa⁵⁹,Foulkes William D⁵⁹,Bianchi Manuel A.⁵⁹,Tolosa Pablo⁵⁹,Alvaro Laura⁵⁹,Eriksson Bergman Louise⁵⁹,Antone Nicoleta⁵⁹,Damian Cristina⁵⁹,

Affiliation:

1. Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy

2. Department of Medical Oncology, U. O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy

3. U. O. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy

4. Breast Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium

5. Department of Medical Oncology, Universite Paris Cité, Institut Curie, Paris, France

6. Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

7. Cancer Survivorship Program–Molecular Predicitors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France

8. Susanne Levy Gertner Oncogenetics Unit, Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center Affiliated to Tel Aviv University, Tel Hashomer, Israel

9. Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands

10. Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

11. Hereditary Cancer Genetics Unit, Medical Oncology Department, Vall d´Hebron University Hospital, Vall d´Hebron Institute of Oncology, Barcelona, Spain

12. Department of General Medical Oncology and Multidisciplinary Breast Center, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium

13. Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India

14. Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio

15. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

16. Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia

17. Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia

18. Department of Oncology and Haematology, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy

19. Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy

20. Department of Surgery, Leon Berard Cancer Center, Lyon, France

21. Gynecologic Oncology Department, European Institute of Oncology (IRCCS), Milan, Italy

22. Cancer Genetics Unit, Bergonie Institute, Bordeaux, France

23. Hereditary Breast and Ovarian Cancer Unit and General Surgery 3–Senology, Surgical Department, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Pavia, Italy

24. Breast Oncology Unit, Sharett Institute of Oncology, Hadassah University Hospital, and Faculty of Medicine, Hebrew University, Jerusalem, Israel

25. UO Gynecology, Department of Medicine and Surgery, University of Milan–Bicocca, IRCCS San Gerardo dei Tintori, Monza, Italy

26. Stroll Cancer Prevention Centre, Jewish General Hospital, and McGill University Medical School, Montreal, Quebec, Canada

27. Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

28. IFOM ETS, AIRC Institute of Molecular Oncology, Milan, Italy

29. Department of Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota

30. Dipartimento di Scienze Chirurgiche, Oncologiche, e Gastroenterologiche, Università di Padova, Padova, Italy

31. Oncologia 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy

32. Department of Oncology/Pathology, Karolinska Institute, and Breast Center, Karolinska University Hospital, Stockholm, Sweden

33. Department of Medical Oncology, Smilow Cancer Hospital at Yale New Haven, New Haven, Connecticut

34. Breast Cancer Center, Hospital Zambrano Hellion–TecSalud, Tecnologico de Monterrey, Monterrey, Mexico

35. Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy

36. Division of Oncology, Department of Hematology, Oncology, and Dermatology, Umberto 1 University Hospital, Rome, Italy

37. Department of Medical Oncology, Centro di Riferimento Oncologico di Avano (CRO) IRCCS, Aviano, Italy

38. Department of Medicine, University of Udine, Udine, Italy

39. Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

40. Department of Oncology-Pathology, Laboratory of Translational Fertility Preservation, Karolinska Institute, Stockholm, Sweden

41. Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden

42. First Department of Oncology, Comenius University and St Elisabeth Cancer Institute, Bratislava, Slovakia

43. Department of Obstetrics and Gynecology, Ludwig Maximilian University (LMU) Hospital, LMU Munich, Germany

44. Department of Medical Oncology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy

45. Department of Medical Oncology, Hospital of Prato, Azienda USL Toscana Centro, Italy

46. Department of Medical Oncology, Centre Henri Becquerel, Rouen, France

47. Department of Medical Oncology, Davidoff Center, Rabin Medical Center, Petah Tikva, Tel Aviv University, Tel Aviv, Israel

48. Department of Medical Oncology, University of Naples Federico II, Napoli, Italy

49. Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain

50. Department of Experimental and Clinical Biomedical Sciences M. Serio, University of Florence, and Radiation Oncology Unit, Oncology Department, Florence University Hospital, Florence, Italy

51. Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland

52. Early Phase Clinical Trials Centre, Medical University of Gdańsk, Gdańsk, Poland

53. Department of Medical Oncology and Breast Surgery, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Brussels, Belgium

54. Oncofertility Consortium and Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing

55. Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy

56. Oncology Division, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

57. Cairo Oncology Center, Cairo, Egypt

58. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts

59. for the BRCA BCY Collaboration

Abstract

ImportanceYoung 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.ObjectiveTo investigate cumulative incidence of pregnancy and disease-free survival in young women who are BRCA carriers.Design, Setting, and ParticipantsInternational, 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.ExposurePregnancy after breast cancer.Main Outcomes and MeasuresPrimary 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.ResultsOf 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 RelevanceIn 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 RegistrationClinicalTrials.gov Identifier: NCT03673306

Publisher

American Medical Association (AMA)

Subject

General Medicine

Link

https://jamanetwork.com/journals/jama/articlepdf/2812828/jama_lambertini_2023_oi_230152_1703181654.30289.pdf

Reference31 articles.

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4. Fertility considerations for reproductive-aged carriers of deleterious BRCA mutations: a call for early intervention.;Fine;JCO Oncol Pract,2022

5. Association of germline BRCA pathogenic variants with diminished ovarian reserve: a meta-analysis of individual patient-level data.;Turan;J Clin Oncol,2021

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