Section 10
Pregnancy after Breast Cancer Treatment

My young patients always ask, “Is it safe to become pregnant after breast cancer treatment?” and the true and honest answer is that I don ’t know. There are retrospective studies from the ’80s that say it’s safe, but those studies are almost discountable, because they are so poorly designed and have so few patients. In the ’90s we had population-based studies with computer linkage programs with their own biases. So, we don’t have any prospective studies and that’s exactly what I’m working on, because otherwise there is no way to obtain a reliable answer.

Currently, I tell the patients that I really don’t know if it is safe to become pregnant after breast cancer treatment because I don’t know if they have micrometastases and whether pregnancy will have a stimulatory effect. It’s not just the total estrogen level — which is 1,000 times greater than any other time in the adult woman’s life — but all the other endocrine, metabolic and immunological happenings of this unique state called pregnancy.

Unfortunately, young women often have such aggressive disease that I am even concerned about the metabolic implications of pregnancy — that the so-called “wear and tear” of the body could decrease survival. I guess I am worried that subsequent pregnancy will eventually be shown to be detrimental to survival at least in some classes of patients.

I usually advise patients to wait as long as they think they can and still be fertile — so that any really aggressive disease will become manifest, and they won’t be dealing with metastatic disease and a newborn baby. But if they are already in an older age group, they can’t wait very long, and therefore they should just go ahead a few months after breast cancer treatment.

— Jeanne Petrek, MD

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