Pregnancy and labour likelihood after breast cancer (a review)

Background. Oncological diseases are the major challenge in modern medicine. This is explained, on the one hand, by a growing number of such patients, changes in the morbidity structure, higher mortality rates and clinical complications. On the other hand, new diagnostic methods and improved therapeutic protocols appear that help save lives, health and fertility of patients. Breast cancer is the most prevailing cancer in reproductive age and pregnant young women, which identifi es its priority in oncology, obstetric gynaecology and reproductive medicine.

Objectives. Assessment of pregnancy likelihood, its course and outcome in women with breast cancer in history.

Мethods. Publication records were mined in Scopus, Web of Science, MedLine, Eliibrary and PubMed under the search depth of 10 years. The query terms were: breast cancer [рак молочной железы], infertility [бесплодие], pregnancy [беременность], preimplantation genetic diagnosis [предимплантационная генетическая диагностика]. Content analysis and descriptive analytics were employed as research tools.

Results. We analysed 94 records, mainly from Scopus, PubMed and Elibrary, and selected 38 publications presenting a structured content analysis of current standards in assessing the likelihood of pregnancy and labour in women with breast cancer in history. The pregnancy likelihood was found to depend on the course of cancer, treatment regimen, female age and basic ovarian reserve. Breast cancer in history was shown to likely incite various obstetric and perinatal complications. Pregnancy scheduling optimal in this female cohort, as well as current approaches to induced termination of pregnancy, have been described.

Conclusion. Pregnancy can be successful with malignant history, including breast cancer, provided an optimal choice of modern treatment settings for minimising the long-term risk of infertility, specialised medical counselling for effective egg and embryo preservation, full pregravid preparation and optimal post-treatment pregnancy scheduling. According to European and American research, no conclusive rationale exists for induced abortion in women having breast cancer during pregnancy or one year after delivery.

pregnancy, breast cancer, infertility, preimplantation genetic diagnosis

1. Aleksandrova L.M., Starinsky V.V., Kaprin A.D., Samsonov Yu..V. Prevention of oncological diseases as the basis of interaction of oncological service with primary link of health care. Research and Practical Medicine Journal. 2017; 4(1): 74–80 (In Russ., English abstract). DOI: 10.17709/2409-2231-2017-4-1-10

2. Hepner A., Negrini D., Hase E.A, Exman P., Testa L., Trinconi A.F., et al. Cancer during pregnancy: the oncologist overview. World J. Oncol. 2019; 10(1): 28–34. DOI: 10.14740/wjon1177

3. Speller B., Micic S., Daly C., Pi L., Little T., Baxter N.N. Oncofertility decision support resources for women of reproductive age: systematic review. J.M.I.R. Cancer. 2019; 5(1): e12593. DOI: 10.2196/12593

4. Sanderson P.A., Critchley H.O., Williams A.R., Arends M.J., Saunders P.T. New concepts for an old problem: the diagnosis of endometrial hyperplasia. Hum. Reprod. Update. 2017; 23(2): 232–254. DOI: 10.1093/humupd/dmw042

5. Lambertini M., Del Mastro L., Pescio M.C., Andersen C.Y., Azim H.A. Jr, Peccatori F.A., et al. Cancer and fertility preservation: international recommendations from an expert meeting. B.M.C. Med. 2016; 14: 1. DOI: 10.1186/s12916-015-0545-7

6. Speller B., Sissons A., Daly C., Facey M., Kennedy E., Metcalfe K., Baxter N.N. An evaluation of oncofertility decision support resources among breast cancer patients and health care providers. B.M.C. Health. Serv. Res. 2019; 19(1): 101. DOI: 10.1186/s12913-019-3901-z

7. Carter J., Chi D.S., Brown C.L., Abu-Rustum N.R., Sonoda Y., Aghajanian C., et al. Cancer-related infertility in survivorship. Int. J. Gynecol. Cancer. 2010; 20(1): 2–8. DOI: 10.1111/IGC.0b013e3181bf7d3f

8. Oktay K., Harvey B.E., Partridge A.H., Quinn G.P., Reinecke J., Taylor H.S., et al. Fertility Preservation in Patients With cancer: ASCO clinical practice guideline update. J. Clin. Oncol. 2018; 36(19): 1994–2001. DOI: 10.1200/JCO.2018.78.1914

9. Ter Welle-Butalid M.E.E., Vriens I.J.H.I., Derhaag J.G.J., Leter E.M.E., de Die–Smulders C.E.C., Smidt M.M., et al. Counseling young women with early breast cancer on fertility preservation. J. Assist. Reprod. Genet. 2019; 36(12): 2593–2604. DOI: 10.1007/s10815-019-01615-6

10. Waimey K.E., Smith B.M., Confi no R., Jeruss J.S., Pavone M.E. Understanding fertility in young female cancer patients. J. Womens. Health. (Larchmt). 2015; 24(10): 812–818. DOI: 10.1089/jwh.2015.5194

11. Jones G., Hughes J., Mahmoodi N., Smith E., Skull J., Ledger W. What factors hinder the decision-making process for women with cancer and contemplating fertility preservation treatment? Hum. Reprod. Update. 2017; 23(4): 433–457. DOI: 10.1093/humupd/dmx009

12. Speller B., Metcalfe K., Kennedy E.D., Facey M., Greenblatt E., Scheer A.S., et al. The “Begin Exploring fertility options, risks and expectations” (before) decision aid: development and alpha testing of a fertility tool for premenopausal breast cancer patients. B.M.C. Med. Inform. Decis. Mak. 2019; 19(1): 203. DOI: 10.1186/s12911–019–0912–y

13. Schmitz C., Baum J., Lax H., Lehmann N., Gromke T., Beelen D.W., et al. fertility preservation and fulfi llment of parenthood after treatment of hematological malignancies: results from the ‘aftercare in blood cancer survivors’ (ABC) study. Int. J. Clin. Oncol. 2020; 25(6): 1187–1194. DOI: 10.1007/s10147-020-01639-4

14. Raphael J., Trudeau M.E., Chan K. Outcome of patients with pregnancy during or after breast cancer: a review of the recent literature. Curr. Oncol. 2015; 22(Suppl 1): S8–S18. DOI: 10.3747/co.22.2338

15. van de Loo L.E.X.M., van den Berg M.H., Overbeek A., van Dijk M., Damen L., Lambalk C.B., et al.; DCOG LATER-VEVO Study Group. Uterine function, pregnancy complications, and pregnancy outcomes among female childhood cancer survivors. Fertil. Steril. 2019; 111(2): 372–380. DOI: 10.1016/j.fertnstert.2018.10.016

16. Trefoux-Bourdet A., Reynaud-Bougnoux A., Body G., Ouldamer L. Pregnancy after breast cancer: A literature review. Presse. Med. 2019; 48(4): 376–383. DOI: 10.1016/j.lpm.2019.01.011

17. Spears N., Lopes F., Stefansdottir A., Rossi V., De Felici M., Anderson R.A., Klinger F.G. Ovarian damage from chemotherapy and current approaches to its protection. Hum. Reprod. Update. 2019; 25(6): 673–693. DOI: 10.1093/humupd/dmz027

18. Elgindy E., Sibai H., Abdelghani A., Mostafa M. Protecting ovaries during chemotherapy through gonad suppression: a systematic review and meta-analysis. Obstet. Gynecol. 2015; 126(1): 187–195. DOI: 10.1097/AOG.0000000000000905

19. Hickman L.C., Llarena N.C., Valentine L.N., Liu X., Falcone T. Preservation of gonadal function in women undergoing chemotherapy: a systematic review and meta–analysis of the potential role for gonadotropin– releasing hormone agonists. J. Assist. Reprod. Genet. 2018; 35(4): 571–581. DOI: 10.1007/s10815-018-1128-2

20. Valachis A., Tsali L., Pesce L.L., Polyzos N.P., Dimitriadis C., Tsalis K., Mauri D. Safety of pregnancy after primary breast carcinoma in young women: a meta-analysis to overcome bias of healthy mother effect studies. Obstet. Gynecol. Surv. 2010; 65(12): 786– 793. DOI: 10.1097/OGX.0b013e31821285bf

21. Stern H.J. Preimplantation genetic diagnosis: prenatal testing for embryos fi nally achieving its potential. J. Clin. Med. 2014; 3(1): 280–309. DOI: 10.3390/jcm3010280

22. Bentivegna E., Maulard A., Pautier P., Chargari C., Gouy S., Morice P. Fertility results and pregnancy outcomes after conservative treatment of cervical cancer: a systematic review of the literature. Fertil. Steril. 2016; 106(5): 1195–1211.e5. DOI: 10.1016/j.fertnstert.2016.06.032

23. Tang M., Webber K. Fertility and pregnancy in cancer survivors. Obstet. Med. 2018; 11(3): 110–115. DOI: 10.1177/1753495X18757816

24. Lambertini M., Ginsburg E.S., Partridge A.H. Update on fertility preservation in young women undergoing breast cancer and ovarian cancer therapy. Curr. Opin. Obstet. Gynecol. 2015; 27(1): 98–107. DOI: 10.1097/GCO.0000000000000138

25. Dobrokhotova Yu.E., Morozova K.V. Opportunities for ovarian reserve preservation in the treatment of oncological diseases. Gynecology. 2019; 21(6): 21–22 (In Russ., English abstract). DOI: 10.26442/20795696.2019.6.190709

26. Dobrokhotova Yu.E., Arakelov S.E., Danelyan S.Zh., Borovkova E.I., Zykov A.E., Zalesskaya S.A., Nagaytseva E.A. Breast cancer associated with pregnancy: a clinical case. Gynecology. 2018; 20(1): 102–108 (In Russ., English abstract). DOI: 10.26442/2079-5696_20.1.102-108

27. Laktionov K.P., Nikolaenko L.O., Berishvili A.I. Breast cancer and woman’s reproductive function (literature review). Tumors of Female Reproductive System. 2015; 11(1): 8–11 (In Russ., English abstract). DOI: 10.17650/1994-4098-2015-1-8-11

28. Zhigalina D.I., Skryabin N.A., Lebedev I.N., Artyukhova V.G., Svetlakov A.V. Preimplantation genetic diagnosis by blastocentesis: problems and perspectives. Russian Journal of Genetics. 2016; 52(1): 1–7 (In Russ., English abstract). DOI: 10.1134/S1022795416010154

29. Dobrokhotova Yu.E., Borovkova E.I., Zaless kaya S.A., Arutyunyan A.M., Borovkov I.M. Chemotherapy during pregnancy: opportunities and risks. Russian Bulletin of Obstetrician-Gynecologist. 2019; 19(3): 81– 85 (In Russ., English abstract). DOI: 10.17116/rosakush20191903181

30. Akhmedova A.I., Lyubasovskaya L.A., Miroshnichenko I.I., Baimeeva N.V., Shmakov R.G. Impact of chemotherapy on the mother–placenta–fetus system: the current status of the problem. Akusherstvo i Ginekologiia. 2018; (9): 14–18 (In Russ., English abstract). DOI: 10.18565/aig.2018.9.14–18

31. Hoellen F., Reibke R., Hornemann K., Thill M., Luedders D.W., Kelling K., et al. Cancer in pregnancy. Part I: basic diagnostic and therapeutic principles and treatment of gynecological malignancies. Arch. Gynecol. Obstet. 2012; 285(1): 195–205. DOI: 10.1007/s00404-011-2058-8

32. Durrani S., Akbar S., Heena H. Breast cancer during pregnancy. Cureus. 2018; 10(7): e2941. DOI: 10.7759/cureus.2941

33. Matthews M.L., Hurst B.S., Marshburn P.B., Usadi R.S., Papadakis M.A., Sarantou T. Cancer, fertility preservation, and future pregnancy: a comprehensive review. Obstet. Gynecol. Int. 2012; 2012: 953937. DOI: 10.1155/2012/953937

34. Hartnett K.P., Mertens A.C., Kramer M.R., Lash T.L., Spencer J.B., Ward K.C., Howards P.P. Pregnancy after cancer: Does timing of conception affect infant health? Cancer. 2018; 124(22): 4401–4407. DOI: 10.1002/cncr.31732

35. Botha M.H., Rajaram S., Karunaratne K. Cancer in pregnancy. Int. J. Gynaecol. Obstet. 2018; 143(Suppl 2):137–142. DOI: 10.1002/ijgo.12621

36. Pustotina O.A. Preconception preparation. Medical Council. 2017; (13): 64–70 (In Russ., English abstract). DOI:10.21518/2079-701X-2017-13-64-70

37. Jadoul P., Guilmain A., Squiffl et J., Luyckx M., Votino R., Wyns C., Dolmans M.M. Effi cacy of ovarian tissue cryopreservation for fertility preservation: lessons learned from 545 cases. Hum. Reprod. 2017; 32(5): 1046–1054. DOI: 10.1093/humrep/dex040

38. Goldrat O., Kroman N., Peccatori F.A., Cordoba O., Pistilli B., Lidegaard O., et al. Pregnancy following breast cancer using assisted reproduction and its effect on long-term outcome. Eur. J. Cancer. 2015; 51(12): 1490–14966. DOI: 10.1016/j.ejca.2015.05.007