The recent appearance of breast cancer in young women has caused confusion in both diagnosis and treatment. Today, it is understood that, although it is a disease of postmenopausal women, breast cancer can occur at any stage of a woman’s childbearing age. The risk factors for these events are not well understood, with the exception of the effect of known mutations in the BRCA1/2 gene on breast/ovarian cancer syndrome, in which the disease usually occurs at a younger age.
Breast cancer is almost exclusively associated with the female, so it was initially recognized that reproductive factors were involved in shaping a woman’s risk of developing the disease. Early menopause and late menopause affect the woman, but they are independent factors of her choices.
Risk factors that depend on a woman’s lifestyle are associated with problems in pregnancy and childbirth. Thus, the risk appears lower in women who give birth to their first child before age 30 and who exclusively breastfeed for more than 6 months (cessation of menstruation during a cesarean section). considered an independent protective factor) and completes the family. At an early age. On the other hand, being single and having a first pregnancy after age 30 have been shown to increase the risk of breast cancer. Also, after each full-term pregnancy, there is a period when the risk of developing cancer increases. This period extends as a woman ages. Thus, the period “at risk” can be up to 5 years for a 25-year-old mother, compared to more than 10 years for a 35-year-old mother.
Surgical treatments and systemic therapies for young women are no different from their older counterparts, but efforts are made to minimize the effects of these treatments on the body, beauty, function and fertility of these young women.
Today, more and more women are turning to assisted reproduction centers to achieve pregnancy. Assisted reproduction procedures (ART) and, in particular, ovarian stimulation procedures for the purpose of collecting eggs for in vitro fertilization (IVF) pose a problem as to their possible involvement in the presence of breast cancer. The concern begins with the knowledge that cases of hyperestrogenism increase the risk of breast cancer and that ovarian stimulation is characterized by rapid and large increases in circulating estrogen. However, this condition has a certain duration and estrogen levels return to normal after ovulation. The real answer to the concern about the association of ovarian stimulation with breast cancer is currently being investigated. This group is heterogeneous and difficult to study. So far, no direct link has been found between IVF and breast cancer incidence. However, it is believed that the risk of breast cancer increases the longer the attempts, the more cycles a woman has (more than 4-6 attempts) and the older she is (over 40).
For the above reasons, it is considered good for a woman to start and complete her family at an early age. However, given the conditions of modern life, this planning is often not possible in a woman’s lifestyle. Thus, knowing the factors that influence the incidence of breast cancer, we can select those people who need close monitoring due to their increased risk, so that if this disease occurs, how it can be effectively treated.
Breast Cancer During Pregnancy or Childbirth
It is a particularly serious condition whose diagnosis and treatment are difficult. Each case must be treated individually in large centers with medical teams specializing in breast surgery, high-risk pregnancies and pregnancies, as well as oncologists.
Today, there is enough experience to support that in all cases of breast cancer, and especially when it occurs during pregnancy, prompt surgical treatment is associated with the best possible outcome. It seems that, in most cases, the pregnancy can easily progress to the birth of a full-term baby. Even the administration of specific chemotherapy, always with careful monitoring of the pregnancy, does not harm the developing fetus, especially when administered after the first trimester of pregnancy.
Pregnancy After Breast Cancer
Once breast cancer is diagnosed and treated, pregnancy is usually discouraged. In the initial period of adjuvant therapy, conditions are unfavorable and it is generally believed (although the hypothesis cannot be empirically tested) that a pregnancy too close to the diagnosis of the disease can lead to a relapse. . After a period that depends on the characteristics of the initial tumor, the subsequent treatment, the diagnosis of the attending physician and, of course, in the absence of recurrence, the problem of procreation returns, especially for immature women. In general, this period is 2 to 3 years.
Young patients with breast cancer, after initial surgical treatment, will undergo treatments that may affect their fertility. Adjuvant chemotherapy can cause premature ovarian failure (the term early menopause is not used), depending on the age of the woman, the chemotherapy drug used, and the dose. These are the criteria that the oncologist should discuss with the patient before starting treatment. Various techniques have been proposed to preserve female fertility and are mentioned below. Adequate assessment of the patient’s age and ovarian reserve is essential for choosing the most appropriate method to preserve the possibility of having a child. Despite the increase in estrogen titer, a single attempt at ovarian stimulation to retrieve eggs is sufficient to collect multiple eggs and is generally acceptable. In some cases, there is no place for fertility preservation methods when conditions are not favorable or when a woman decides to have a child after the onset of uterine insufficiency. In these patients, methods that do not contain hormonal stimulation, such as egg donation for embryo transfer, in vitro fertilization or adoption, should be recommended from the start.
It is noteworthy that the appropriate time to inform the patient about her reproductive options is shortly after the surgical treatment and before starting any systemic treatment. Every patient of childbearing age must be informed in a timely manner and given the opportunity to choose a method to preserve the possibility of having a child in the future. It is internationally recognized that the time available for emotional processing and decision making is very limited, but due to efforts to achieve better disease outcomes, reproductive criteria are marginalized.
Recommended options for fertility preservation in women with breast cancer.
| Choice | For | Contra |
| Recommended ways to preserve fertility | ||
| 1. IVF and storage (freezing) of fertilized eggs | – Clinically available method – Relatively good results in achieving pregnancy with current experience | – Having a parent partner is necessary – the resulting embryos legally belong to both parents – ovulation is required, so the onset of ovarian stimulation and IVF may be delayed – CMT may be delayed – If the BRCA patient is a carrier of a mutation can. Transfer it to the fetus. |
| 2. Egg retrieval to activate the ovaries and preserve the eggs | – Medically available. – No partner required. | – Ovarian stimulation is necessary. – The onset of CMT can be delayed. – If the patient has the BRCA mutation, she can pass it on to the fetus. |
| 3. Laparoscopic extraction and preservation of ovarian or ovarian tissue and subsequent reimplantation | – No partner required. – Ovarian stimulation is not necessary and estrogen levels are not subsequently increased. – Does not delay the onset of CMT. | – There have been few campaigns so far, although research continues. – If the patient has the BRCA mutation, she can pass it on to the fetus. – Surgical interventions are necessary. |
| 4. Suppression of ovarian function during HCM with GnRH analogues | – No partner required. – Simple and minimally invasive method – Does not delay the onset of CMT. | – It has not been shown to actually preserve ovarian function. – Unknown drug effects |
The Breast Department of the First Clinic of Gynecology and Obstetrics at Hospital is an approved referral center to treat all these cases according to international standards. In collaboration with the hospital’s oncology department, he brings his experience and knowledge in the proper management of breast cancer cases in young women, pregnant and lactating women and women who wish to preserve their fertility after diagnosis.
