On October 29, 2015, the Fifth Plenary Session of the 18th Central Committee decided to fully liberalize the two-child policy. At this point, the one-child policy, which had been implemented for more than 30 years, was officially declared to be over. That night a patient sent me a WeChat consultation: “Dr. Lv, today the news came online, the second child liberalization, it really makes people mixed feelings, can be born when the policy does not allow, now the policy allows and got this disease, I have done surgery 14 months, has been taking tamoxifen, but also has been a normal period …….. ” . Lv Pengwei, Breast Surgery Department, First Affiliated Hospital of Zhengzhou University Can breast cancer patients have children or not? It has been a rather tangled issue.
The number of young breast cancer patients is gradually increasing, and a significant number of these patients have not yet had children before the diagnosis of breast cancer, or still have the need to have a second child after treatment. This need is even more evident in the “second child era” when the policy allows it. However, breast cancer is a systemic and systemic disease, and various treatments for breast cancer may affect the fertility of patients. Does breast cancer treatment during pregnancy affect the mother and fetus? Should breast cancer patients terminate their pregnancy or not? Fertility or survival, that is the dilemma.
There is not much research on the relationship between breast cancer and pregnancy in China. However, the findings of some foreign guidelines and clinical studies are available for our reference. The Royal College of Obstetricians and Gynaecologists (RCOG, Royal College of Obstetricians and Gynaecologists) updated the Guidelines on Breast Cancer and Pregnancy in 2011. The sources of evidence for the guidelines are Medline, Pubmed, all EBM reviews, randomized controlled trials in EMBASE and TRIP, systematic reviews, meta-analyses, cohort studies and case-control studies, with most of the data coming from clinical studies prior to 2009. Some of the points from this guideline are summarized in this article, with references to other evidence-based medical evidence as well. Despite the improved prognosis of hormone receptor-positive patients with amenorrhea after endocrine therapy, studies have shown that post-treatment fertility does not affect the long-term survival of breast cancer patients and can even reduce the relative risk of patient death. Some studies also suggest that there is no statistically significant difference in the incidence of genetic abnormalities and childhood-onset tumors in offspring born to cancer patients compared to the general population. Chemotherapy and endocrine therapy have an impairment of ovarian function in women, but due to the hormone-dependent nature of some breast cancers, the impairment of ovarian function partially acts as a function of endocrine therapy. Some patients may stop menstruating or even lose their fertility at the end of the combined treatment. Therefore, if after the diagnosis of breast cancer, the patient still has plans to have children, she must inform her competent doctor about the use of ovarian protection before resorting to chemotherapy and endocrine therapy. Ovarian protection can be achieved by using drugs such as goserelin and leuprolide (although these drugs do not protect fertility in 100% of patients), which need to be started about 2 weeks before systemic treatment. There is also recourse to assisted reproductive technology (this requires a consultation at a fertility center). Women with breast cancer can be treated during pregnancy without an increased risk of adverse fetal and maternal outcomes, according to an article in The Lancet Oncology, an international study published online Aug. 16 in The Lancet Oncology. However, the researchers did find that fetuses exposed to chemotherapy in utero had lower birth weights and more complications than unexposed fetuses, but there were no significant differences between the two groups. Importantly, there were no major birth defects. However, given the medical practices in the country, most mammologists would not advise their patients to go for pregnancy during chemotherapy and endocrine therapy. Especially in the first trimester of pregnancy, these oncology drugs are more likely to cause fetal abnormalities. Bone scans and pelvic x-rays are not recommended during pregnancy. Breastfeeding is not recommended for patients who are taking tamoxifen or using Herceptin. Breast cancer patients should consult with their mammographer and obstetrician/gynecologist before becoming pregnant. Patients taking tamoxifen are advised to stop taking the drug for at least 3 months before considering pregnancy. Before preparing for pregnancy, breast cancer patients should have some routine tests to rule out tumor recurrence and metastasis. Pregnancy is no longer recommended for patients with metastatic breast cancer that has been diagnosed as advanced (stage 4). Previous evidence suggesting that pregnancy does not increase the recurrence of breast cancer has been pregnancy after breast cancer treatment is completed. So some patients ask if they interrupt their normal treatment for breast cancer, get pregnant and have a baby, and then supplement their treatment afterwards. Whether this will increase recurrence is something I have not found information on. But for patients with intraductal and lobular carcinoma in situ, my personal opinion is that you can go ahead and get pregnant with more confidence. For how long after the diagnosis of breast cancer before getting pregnant, it is generally recommended at least 3 years later. This is because most recurrences and metastases of breast cancer occur within 3 years of diagnosis. Since chemotherapy and molecular targeted therapy may affect heart function, pregnancy can also increase the cardiopulmonary burden. Echocardiography should be emphasized during pregnancy. Can I breastfeed if I have given birth after breast cancer surgery. Currently, breastfeeding is considered possible on the healthy side of the breast. In patients with breast-conserving surgery, many patients have lost the breastfeeding function on the affected side due to radiation therapy on the affected side and tissue fibrosis after radiation therapy.
The question of whether breast cancer patients should have children, especially those who are older, should take advantage of the policy to have a second child. It is indeed a rather tangled issue. Before preparing for pregnancy, one must consult one’s supervising doctor because he knows the patient’s condition best, and it is also better to consult an obstetrician who will give some professional advice on obstetrics. The actual fact is that you will be able to get a lot more than just a few of the most popular and most popular items.