Young women who recover from breast cancer have long faced an agonizing choice: jeopardize their chances of having children or risk the possibility of their cancer quickly returning.
The powerful hormone blockers many take for years after their tumors are removed help keep the cancer from recurring, but the drugs can be toxic for a developing fetus.
Now a new international study led by Boston researchers offers hope. It found that allowing up to a two-year break in hormone suppression therapy to allow women the chance to get pregnant and breast feed did not appear to increase the risk of cancer recurring during the roughly 3½ years that participants were followed.
The findings, published Wednesday in the New England Journal of Medicine, focused on women with hormone receptor–positive breast cancer, the most common form.
Doctors usually recommend that women with this type of cancer delay pregnancy for five to 10 years while they undergo follow-up hormone suppression therapy, which reduces their chances of having a recurrence. The medication slows or stops the growth of hormone-sensitive tumors by blocking the body’s ability to produce hormones or by interfering with their effects on breast cancer cells.
But that years-long pause in childbearing can be distressing for women keenly aware that their biological clock is ticking as their peak reproductive years slip away.
Historically, doctors have also been concerned that elevated levels of the hormones estrogen and progesterone during pregnancy would increase the risk of the breast cancer coming back
“It’s no longer sufficient to say, ‘You survived your cancer, you should be grateful and figure out something else’ ” for having children, said Dr. Ann Partridge, vice chair of medical oncology at the Dana-Farber Cancer Institute and lead author of the study.
The new findings, Partridge said, give women facing the dilemma vital information that helps them “live their lives, and for many to have a biological child . . . an important consideration.”
Among Partridge’s patients is Shayla Johnson, a 41-year-old Freetown resident who participated in the study. Johnson at 34 was diagnosed with stage two breast cancer and an inherited gene mutation that raises her risk for the breast cancer recurring, as well as for ovarian and other cancers.
“We were planning to start a family when I was diagnosed,” Johnson said. “That put quite a hold on our plans.”
Johnson had a double mastectomy, eight rounds of chemotherapy, a short break, and then enrolled in the study in 2017 as she started hormone-suppression therapy for two years.
In the summer of 2019, she paused the hormone therapy, took the specified three months to let the medication wash out of her system, and went on her break, attempting to get pregnant.
It wasn’t easy. She had frozen her eggs to protect them during chemotherapy and needed four rounds of in vitro fertilization, which were interrupted for several anxious months early in the pandemic when all nonessential health services were shut down.
And then, success. Ronin was born Jan 6, 2022, at 9 pounds, 11 ounces and healthy.
“After so many rounds [of in vitro], I was almost done, but I figured I went through so many things in my life, I kept pushing,” Johnson said. “Being a mother was the most important thing for me, and I couldn’t imagine my life without my son.”
The study included 516 patients at 116 centers across 20 countries on four continents. The women ranged in age from 27 to 43 with a median age of 37.Women were eligible if they had had stage one, two, or three hormone receptor–positive breast cancer; had received hormone therapy for at least 18 months and for no more than 30 months; and wished to temporarily discontinue therapy to attempt pregnancy.
Nineteen women did not continue in the study, but among the remaining 497, 368 (74 percent) had at least one pregnancy and 317 (63.8 percent) had at least one live birth. In total, 365babies were born.
The researchers tracked the women after their pregnancy break for a median stretch of 41months, and 44 of them, or 8.9 percent, developed another incidence of breast cancer. But that number was essentially the same as the total recorded in a control group of women who were similar to those in the study — similar ages, tumor sizes, height and weight — but who did not stop their hormone therapy to take a pregnancy break.
“Now if a patient asks me about this [stopping therapy to get pregnant], I have a good study, that was well done, and I can show them the data,” said Dr. Patricia Ganz, associate director for population science research at the Jonsson Comprehensive Cancer Center at UCLA.
Ganz, who was not involved in the study, has spent 30 years researching outcomes for breast cancer patients.
“These kinds of studies become the educating and decision-making tool I can use with patients,” she said. “This informs the discussion because we had no data before.”
An editorial in the New England Journal of Medicine that accompanied the study concluded, “Physicians should now incorporate these positive data into their shared decision-making process with patients.”
Dr. Susan Domchek, a breast cancer specialist at Abramson Cancer Center and executive director of the Basser Center for BRCA at Penn Medicine, said the discussion about pregnancy comes up often among the many young women with breast cancer she has cared for.
She described the study’s findings as “a gift we can give our patients.”
But Domchek, who also was not involved in the study, said the findings are by no means “a green light” that says pausing hormone therapy is risk free, noting the 44 cases of recurrent breast cancer.
“I have patients and their number one goal is achieving a pregnancy,” she said. “They may look at these numbers and say, ‘Great, I will take that risk.’ Others may not want to take a chance of being pregnant and having a recurrence, and that’s a whole other kettle of fish.”
The study found that most women who took the temporary pregnancy break did resume the hormone therapy afterward, though roughly 15 percent of the patients who had been expected to resume therapy had not done so by four years after interrupting the treatment.
Ganz said the side effects of hormone therapy, which include hot flashes, sweats, insomnia, vaginal dryness, and muscular and joint aches and pains, can be so unpleasant that many women stop taking the medication.
But Partridge and her colleagues in the hormone therapy study intend to continue following the women, because breast cancer recurrences are reported up to 20 years after diagnosis among patients with hormone receptor–positive cancer. The planned follow-up will be at 10 years.
Johnson, who had delayed resuming her hormone therapy while she considered, and then decided against, having a second child, is planning to start back up soon for the recommended three additional years.
But she admits she has been dragging her feet because of the side effects.
“I have been through stuff my whole life, and cancer was the hardest,” she said. “But the reward of being Ronin’s mother is so great.”
Kay Lazar can be reached at kay.lazar@globe.com Follow her on Twitter @GlobeKayLazar.
"breast" - Google News
May 04, 2023
https://ift.tt/3nuPHg2
New hope for breast cancer survivors: Study finds a break in hormone suppression therapy to bear children is relatively ... - The Boston Globe
"breast" - Google News
https://ift.tt/7qo5gJN
https://ift.tt/5jup6oC
Bagikan Berita Ini
0 Response to "New hope for breast cancer survivors: Study finds a break in hormone suppression therapy to bear children is relatively ... - The Boston Globe"
Post a Comment