Does Pregnancy Worsen Breast Cancer Outcome?

An Interview With Frédéric Amant, MD, PhD

Frédéric Amant, MD, PhD; Linda Brookes, MSc

Disclosures

September 17, 2013

In This Article

Confirmation From Largest Study to Date

Medscape: How do your latest findings[5] build on the data from 2 earlier studies that also focused on treatment of BCP that you published last year?[8,9]

Prof. Amant: The pivotal study we did was a long-term assessment in children where, after chemotherapy, the main result is that children suffer from prematurity but they do not suffer from chemotherapy.[8] Fetal exposure to chemotherapy was not associated with increases in central nervous system, cardiac, or auditory morbidity, or with impairments to general health and growth, compared with the general population. In other studies we showed that not all chemotherapy passes to the fetus, so these studies explained, basically, why the fetus is not suffering from the chemotherapy. We also reported on the obstetric and neonatal outcomes in the same GBG/CIP patient series as our most recent study.[9] However, there was little focus on prognosis in these studies, and because we believed that this was so important, we did a second study focused on prognosis. In order to do this we also had to construct a control group. Previous studies were underpowered to answer the question and results were conflicting, with some studies pointing toward a worse outcome and others toward an equal outcome. I think that our study was sufficiently strong to draw final and more robust conclusions. It was the largest-ever study of long-term prognosis in women treated for BCP. There were 6 or 7 similar studies carried out previously, but most of them had fewer than 100 patients per group, whereas we had more than 300 and we compared them with a good control group, which was not always available in the other studies. They resulted in conflicting data because they were not powered sufficiently.

Medscape: As you and your colleagues pointed out, although survival was similar in pregnant and nonpregnant patients in your study, there did appear to be a modest effect of pregnancy on DFS and OS. Did you see more effect in any of the subgroups? Earlier studies linked pregnancy-associated breast cancer (PABC) with more advanced disease, larger tumors, and increased percentage of hormone receptor-negative tumors.

Prof. Amant: We did not see overall differences for subgroups, but to be really sure we may want to look at larger patient numbers. Nevertheless, I think that one important message from our study should be that stage per stage, the prognosis in pregnant women is not worse. If you take a tumor of 5 cm in a pregnant and a nonpregnant woman and each has 1 positive lymph node, then pregnancy does not make a difference. If you look at all women with BCP, however, then the prognosis is a little worse, because in general their tumors tend to be larger when compared with nonpregnant women, due to the physiologic alterations during pregnancy. So, stage per stage, the prognosis is not worse in pregnancy. If there are more, larger tumors during pregnancy, then you can expect that the prognosis will be somewhat worse when compared with nonpregnant women of the same age.

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