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

Current Treatment Not in Line With Recent Evidence

Medscape: How do you think your studies to date have influenced the treatment of breast cancer in pregnancy?

Prof. Amant: I started the CIP project in 2005 after I realized how few data there were on the prognosis of treatment in pregnancy and the outcome of the children with respect to the impact of chemotherapy and radiotherapy. This was also the reason the GBG started to look at the clinical data in breast cancer. We realized that many patients were either having a termination of pregnancy or their breast cancer treatment was being delayed until after delivery of the baby, which was suboptimal for the mother and often resulted in iatrogenic preterm delivery. Those were the reasons why we started our registries, and I am convinced that by doing so we have changed clinical practice. For example, in Belgium, at the time our group started, I had to convince not just patients but primarily physicians that chemotherapy was not as detrimental for the health of the fetus as we had feared. And after I had explained that it was possible to treat patients with chemotherapy during pregnancy, physicians at the district hospitals would ask patients to sign a document agreeing that the physician was not responsible if any event occurred. That is where we have come from. Now patients come to see me on their own for a second opinion, and in some cases district hospital physicians treat these patients with chemotherapy without even contacting me first. So, I am convinced that our studies have changed the clinical conduct of treatment.

Medscape: One of the coauthors of your studies is quoted as saying that "treatment for breast cancer is still not the same as for nonpregnant women in many countries and hospitals" despite growing evidence that this is not the best course of action.[11] You published the results of a survey earlier this year showing that termination of pregnancy, delay of maternal treatment, and iatrogenic preterm delivery are still frequently applied in the management of pregnant cancer patients throughout Europe.[12] These results suggest that current treatment is not in line with recent evidence. Is there room for improvement of the oncologic treatment of pregnant women?

Prof. Amant: I get regular invitations to speak at national and international conferences. The impact of these presentations is difficult to guess. I think our studies can definitely have an impact, but it can vary in different geographical regions, even within Europe. There are religious, cultural, and national aspects that have to be taken into account. For example, I spoke on this topic last year at a meeting in Dublin, Ireland,[13] and I know that it had a major impact on the audience. At the time, the Irish government was voting on a new law about termination of pregnancy, and groups that wanted to protect the life of the fetus invited me to speak. They publicized the results of our study widely because it gave them an argument as to why these pregnancies should not terminated, in opposition to those who favored abortion. So, that was a political argument and we provided new data that were supportive of one of the groups. On the other hand, in Scandinavia there are laws stating that the life of the mother is priority, so physicians there have been reluctant to give chemotherapy during pregnancy. So, it is difficult to generalize.

Medscape: How do your studies affect views about termination of pregnancy in breast cancer patients?

Prof. Amant: We used to believe that because of pregnancy, the mother has a worse outcome, so it was better to terminate a pregnancy. But termination of pregnancy will not improve prognosis. There is a prognosis, and this prognosis is unaffected by the pregnant state.

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