Safety of pregnancy after breast cancer in young women with hormone receptor-positive disease: a systematic review and meta-analysis

L Arecco; E Blondeaux; M Bruzzone; M M Latocca; E Mariamidze; S Begijanashvili; E Sokolovic; G Gentile; G Scavone; S Ottonello; A Boutros; I Vaz-Luis; C Saura; R A Anderson; I Demeestere; H A Azim Jr; E de Azambuja; F A Peccatori; L Del Mastro; A H Partridge; M Lambertini

doi:10.1016/j.esmoop.2023.102031

Safety of pregnancy after breast cancer in young women with hormone receptor-positive disease: a systematic review and meta-analysis

ESMO Open. 2023 Dec;8(6):102031. doi: 10.1016/j.esmoop.2023.102031. Epub 2023 Oct 23.

Authors

L Arecco¹, E Blondeaux², M Bruzzone², M M Latocca³, E Mariamidze⁴, S Begijanashvili⁵, E Sokolovic⁶, G Gentile⁷, G Scavone³, S Ottonello³, A Boutros⁸, I Vaz-Luis⁹, C Saura¹⁰, R A Anderson¹¹, I Demeestere¹², H A Azim Jr¹³, E de Azambuja¹⁴, F A Peccatori¹⁵, L Del Mastro¹⁶, A H Partridge¹⁷, M Lambertini¹⁸

Affiliations

¹ Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova. Electronic address: https://twitter.com/Lucarecco.
² U.O. Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
³ Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova.
⁴ Department of Oncology and Hematology, Todua Clinic, Tbilisi.
⁵ Department of Clinical Oncology, American Hospital, Tbilisi, Georgia.
⁶ Clinic of Oncology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
⁷ Medical Oncology Unit B, Department of Radiology, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome.
⁸ Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Department of Medical Oncology, Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
⁹ Unit 981-Molecular Predictors and New Targets in Oncology, Interdisciplinary Department for the Organization of Patient Pathways (DIOPP), INSERM and Institut Gustave Roussy, Paris, France.
¹⁰ Breast Cancer Unit, Medical Oncology Service, Vall d'Hebron University Hospital, Barcelona, Spain.
¹¹ MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK.
¹² Research Laboratory on Human Reproduction, Fertility Clinic (HUB-Erasme), Brussels, Belgium.
¹³ Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico.
¹⁴ Academic Trials Promoting Team, Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B), Brussels, Belgium.
¹⁵ Fertility and Procreation Unit, Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy.
¹⁶ Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova.
¹⁷ Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA.
¹⁸ Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova. Electronic address: matteo.lambertini@unige.it.

Abstract

Background: Despite increasing evidence on the safety of pregnancy after anticancer treatments in breast cancer survivors, many physicians and patients remain concerned about a potential risk of pregnancy specifically in the case of hormone receptor-positive breast cancer.

Materials and methods: A systematic literature search of Medline, Embase and Cochrane library with no language or date restriction up to 31 March 2023 was carried out. To be included, articles had to be retrospective and prospective case-control and cohort studies as well as clinical trials comparing survival outcomes of premenopausal women with or without a pregnancy after prior diagnosis of hormone receptor-positive breast cancer. Disease-free survival (DFS) and overall survival (OS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Study protocol is registered in PROSPERO (n. CRD42023394232).

Results: Out of 7796 screened studies, 8 were eligible to be included in the final analysis. A total of 3805 patients with hormone receptor-positive invasive early breast cancer were included in these studies, of whom 1285 had a pregnancy after breast cancer diagnosis. Median follow-up time ranged from 3.8 to 15.8 years and was similar in the pregnancy and non-pregnancy cohorts. In three studies (n = 987 patients) reporting on DFS, no difference was observed between patients with and those without a subsequent pregnancy (HR 0.96, 95% CI 0.75-1.24, P = 0.781). In the six studies (n = 3504 patients) reporting on OS, patients with a pregnancy after breast cancer had a statistically significant better OS than those without a pregnancy (HR 0.46, 95% CI 0.27-0.77, P < 0.05).

Conclusions: This systematic review and meta-analysis of retrospective cohort studies provides updated evidence that having a pregnancy in patients with prior history of hormone receptor-positive invasive early breast cancer appears safe without detrimental effect on prognosis.

Keywords: breast cancer; hormone receptor-positive disease; oncofertility; pregnancy; premenopausal patients.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Breast Neoplasms* / drug therapy
Disease-Free Survival
Female
Humans
Pregnancy
Prognosis
Proportional Hazards Models
Retrospective Studies