Pregnancy after breast cancer? Today it is possible (thanks also to Italian research)

The pregnancy
post
tumor a topic on which Italy has set a precedent in the world. Over the last 20 years, the group of researchers from the IRCCS Policlinico San Martino University Hospital in Genoa has presented one study after another in rooms packed with oncologists at the most relevant scientific conferences, from that of the American Society of Clinical Oncology, to San Antonio Breast Cancer Symposium in Texas, to that of the European Society of Medical Oncology, just to name a few. Each study a step forward, a new conquest. The goal was to enable young women who got breast cancer to be able to become mothers once the treatment is complete. Safe both for them, without jeopardizing the effectiveness of anti-cancer therapies, and for the unborn. An objective which, research after research, has now largely been achieved.

Desire for motherhood

The probability of definitive healing from breast cancer surpasses currently 60% – explains Lucia Del Mastro, Full Professor and Director of the Medical Oncology Clinic of the IRCCS Policlinico San Martino Hospital, University of Genoa -. We must increasingly set ourselves the goal of preserving the psycho-physical well-being of our patients even after the administration of treatments that are often still invasive. The desire for motherhood is a right that oncology can and must be able to guarantee to a growing number of women. In Genoa we managed to create a virtuous model also for other areas of the Peninsula. At San Martino the patient who must undergo at chemotherapy he manages to have a direct access to egg and ovarian tissue freezing procedures. The intuition, which we had over 20 years ago, to create a structured collaboration between the medical oncology department and the medically assisted procreation center directed by Paola Anserini, proved successful.

Preserve fertility

About 3,500 women Italians have to face one every year diagnosed with breast cancer before the age of 40, when they have not yet had children or have not completed their family wish. And the number of cases in increasealso thanks to the tendency to seek the first pregnancy at an increasingly advanced age. Once upon a time the only solution to having children was to freeze the eggs before the treatment and proceed, once recovered, with in vitro fertilization, then we understood how to put the ovaries to rest during chemotherapy, so as not to damage them and preserve the fertility of young women
– recalls Del Mastro -. Some surgeriessome types of radiotherapy and chemotherapy I am associated with a high risk of temporary or permanent infertility, in females and males. Many factors can intervene, but today we can and must safeguard the possibility of becoming parents after cancer, there are many strategies.
Just as there are safe strategies for those unfortunate cases in which breast cancer is diagnosed during gestation: there are more or less 150 cases per year in our country and the pregnancy does not always have to be interrupted because research has made progress and they can be saved. mothers, allowing them to give birth to healthy babies, without increasing the risk of pathologies.

Few Italians take advantage of the opportunity

While having a healthy baby without running risks for the mother is feasible today, only 5 women out of 100 are aware that it is possible to preserve fertility. A'opportunity that exists, safe for patients (who can also suspend hormonal treatments to carry on a pregnancy) and for the unbornbut which comes to our country still little exploited underlines Del Mastro, a pioneer in this sector. From his Genoese group some scientific research has arrived that has improved the approach to fertility preservation at an international level. And in the Ligurian capital it is held, the conference is on 12 and 13 January
Back from San Antonio
one of the most important national conferences on breast cancer, where the major innovations coming from the American San Antonio Breast Cancer Symposium (which took place in December 2023) are discussed and presented.

Women with BRCA gene mutation

Even in the USA, oncofertility has been widely highlighted and a study coordinated by San Martino e published simultaneously in the prestigious American magazine JAMA, has added a new piece relevant for young patients with safe BRCA.PMA gene mutation and green light also for BRCA mutated. Illustrating the data was Matteo Lambertini, Associate Professor of Medical Oncology at the IRCCS Policlinico San Martino Hospital, University of Genoa: More than 70 centers around the world were involved and over 4,700 young women with hereditary breast cancer were enrolled to the presence of one mutation to the BRCA genes – explains the oncologist -. After completing oncological treatments and a correct observation period, one in five women managed to get pregnant. Additionally, having a pregnancy after breast cancer diagnosis in BRCA mutated women who have undergone prior chemotherapy results safe for mothers (i.e. without any increased risk of tumor recurrence) both for children (i.e. without any increased risk of malformations or other pregnancy complications).

Discontinuation of hormone therapy

During the American congress, an in-depth study of the international POSITIVE study was also presented: Last year it was demonstrated that young women affected by early stage breast cancer can interrupt adjuvant hormone therapy for two years (i.e. following surgery) to try to get pregnant – clarifies Lambertini -. This year's data shows that, in these patients, the use of medically assisted procreation safe without increasing the risk of breast cancer recurrence.

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