Schwangerschaft nach Mammakarzinom

Zusammenfassung

Die Frage einer Schwangerschaft nach Mammakarzinom stellt sich zunehmend häufig. Chemotherapie insbesondere mit Alkylantien wirkt sich negativ auf die konsekutive Fertilität aus. In überwiegend retrospektiven Studien kann kein nachteiliger Effekt einer Schwangerschaft für die Prognose ermittelt werden. Das relative Risiko bez. Überleben bei Schwangerschaft nach Mammakarzinom liegt zwischen 0,2 und 0,8. Ein kurzes Intervall von weniger als 6 Monaten nach Mammakarzinom könnte die Prognose negativ beeinflussen. Der Nodalstatus scheint ohne Einfluss zu sein. Ein „healthy mother”-Effekt könnte in erheblichem Maße zu einer Bias der Studienergebnisse beitragen. Für eine hormonelle Stimulation zur Sterilitätstherapie nach Mammakarzinom ist die Studienlage unzureichend, so dass hier keine valide Empfehlung gegeben werden kann.

Abstract

The number of patients asking for pregnancy after being treated for breast cancer is steadily increasing. Chemotherapy, in particular alkylants, might impair fertility. The prognosis of breast cancer is not negatively affected by a consecutive pregnancy as shown in retrospective studies. The relative risk concerning survival is reduced to 0.2-0.8 by pregnancy. However, a short interval of less than 6 months after breast cancer treatment could have a negative effect. The nodal status is without significance. Study results could be severely biased by a socalled “healthy mother” effect. There is no sufficient data to allow any conclusions on the effect of hormonal stimulation for infertility treatment in breast cancer patients.

Schlüsselwörter

Mammakarzinom - Schwangerschaft - Prognose

Key words

Breast cancer - pregnancy - prognosis

Literatur

• 1 Bines J, Oleske D M, Cobleigh M A. Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer.  J Clin Oncol. 1996;  14 1718-1729
• 2 Blumenfeld Z, Dann E, Avivi I, Epelbaum R, Rowe J M. Fertility after treatment for Hodgkin's disease.  Ann Oncol. 2002;  13 Suppl 1 138-147
• 3 Boostanfar R, Jain J K, Mishell D R, Paulson R J. A prospective randomized trial comparing clomiphene citrate with tamoxifen citrate for ovulation induction.  Fertil Steril. 2001;  75 1024-1026
• 4 Botelho F, Clark D A. How might pregnancy immunize against breast cancer?.  Am J Reprod Immunol. 1998;  39 279-283
• 5 Brown J R, Modell E, Obasaju M, King Y K. Natural cycle in-vitro fertilization with embryo cryopreservation prior to chemotherapy for carcinoma of the breast.  Hum Reprod. 1996;  11 197-199
• 6 Clark R M, Chua T. Breast cancer and pregnancy: the ultimate challenge.  Clin Oncol (R Coll Radiol). 1989;  1 11-18
• 7 Cooper D R, Butterfield J. Pregnancy subsequent to mastectomy for cancer of the breast.  Ann Surg. 1970;  171 429-433
• 8 Dow K H, Harris J R, Roy C. Pregnancy after breast-conserving surgery and radiation therapy for breast cancer.  J Natl Cancer Inst Monogr. 1994;  16 131-137
• 9 El Hussein E, Tan S L. Successful in vitro fertilization and embryo transfer after treatment of invasive carcinoma of the breast.  Fertil Steril. 1992;  58 194-196
• 10 Gelber S, Coates A S, Goldhirsch A, Castiglione-Gertsch M, Marini G, Lindtner J, Edelmann D Z, Gudgeon A, Harvey V, Gelber R D. International Breast Cancer Study Group . Effect of pregnancy on overall survival after the diagnosis of early-stage breast cancer.  J Clin Oncol. 2001;  19 1671-1675
• 11 Ginsburg E S, Yanushpolsky E H, Jackson K V. In vitro fertilization for cancer patients and survivors.  Fertil Steril. 2001;  75 705-710
• 12 Goldhirsch A, Gelber R D, Castiglione M. The magnitude of endocrine effects of adjuvant chemotherapy for premenopausal breast cancer patients. The International Breast Cancer Study Group.  Ann Oncol. 1990;  1 183-188
• 13 Hankey B F, Miller B, Curtis R, Kosary C. Trends in breast cancer in younger women in contrast to older women.  J Natl Cancer Inst Monogr. 1994;  16 7-14
• 14 Harvey J C, Rosen P P, Ashikari R, Robbins G F, Kinne D W. The effect of pregnancy on the prognosis of carcinoma of the breast following radical mastectomy.  Surg Gynecol Obstet. 1981;  53 723-725
• 15 Koyama H, Wada T, Nishizawa Y, Iwanaga T, Aoki Y. Cyclophosphamide-induced ovarian failure and its therapeutic significance in patients with breast cancer.  Cancer. 1977;  39 1403-1409
• 16 Kroman N, Jensen M B, Melbye M, Wohlfahrt J, Mouridsen H AT. Should women be advised against pregnancy after breast-cancer treatment?.  Lancet. 1997;  350 319-322
• 17 Lethaby A E, O'Neill M A, Mason B H, Holdaway I M, Harvey V J. Overall survival from breast cancer in women pregnant or lactating at or after diagnosis. Auckland Breast Cancer Study Group.  Int J Cancer. 1996;  67 751-755
• 18 Levine M N, Bramwell V H, Pritchard K I, Norris B D, Shepherd L E, Abu-Zahra H, Findlay B, Warr D, Bowman D, Myles J, Arnold A, Vandenberg T, MacKenzie R, Robert J, Ottaway J, Burnell M, Williams C K, Tu D. Randomized trial of intensive cyclophosphamide, epirubicin, and fluorouracil chemotherapy compared with cyclophosphamide, methotrexate, and fluorouracil in premenopausal women with node-positive breast cancer. National Cancer Institute of Canada Clinical Trials Group.  J Clin Oncol. 1998;  16 2651-2658
• 19 Malamos N A, Stathopoulos G P, Keramopoulos A, Papadiamantis J, Vassilaros S. Pregnancy and offspring after the appearance of breast cancer.  Oncology.. 1996;  53 471-475
• 20 Meurer L N, Lena S. Cancer recurrence and mortality in women using hormone replacement therapy: meta-analysis.  J Fam Pract. 2002;  51 1056-1062
• 21 Mignot L, Morvan F, Berdah J, Querleu D, Laurent J C, Verhaeghe M, Fontaine F, Marin J L, Gorins A, Marty M. Pregnancy after treated breast cancer.  Results of a case-control study Presse Med. 1986;  15 1961-1964
• 22 Oktay K, Buyuk E, Davis O, Yermakova I, Veeck L, Rosenwaks Z. Fertility preservation in breast cancer patients: IVF and embryo cryopreservation after ovarian stimulation with tamoxifen.  Hum Reprod. 2003;  18 90-95
• 23 Petrek J A. Pregnancy safety after breast cancer.  Cancer. 1994;  74 Suppl 1 528-531
• 24 Recchia F, Sica G, De Filippis S, Saggio G, Rosselli M, Rea S. Goserelin as ovarian protection in the adjuvant treatment of premenopausal breast cancer: a phase II pilot study.  Anticancer Drugs. 2002;  13 417-424
• 25 Reyno L M, Levine M N, Skingley P, Arnold A, Abu Zahra H. Chemotherapy induced amenorrhoea in a randomised trial of adjuvant chemotherapy duration in breast cancer.  Eur J Cancer. 1992;  29 A 21-23
• 26 Sankila R, Heinavaara S, Hakulinen T. Survival of breast cancer patients after subsequent term pregnancy: “healthy mother effect”.  Am J Obstet Gynecol.. 1994;  170 818-823
• 27 Schilsky R L, Lewis B J, Sherins R J, Young R C. Gonadal dysfunction in patients receiving chemotherapy for cancer.  Ann Intern Med. 1994;  16 125-129
• 28 Surbone A, Petrek J A. Childbearing issues in breast carcinoma survivors.  Cancer. 1997;  79 1271-1278
• 29 Sutton R, Budzar A U, Hortobagyi G N. Pregnancy and offspring after adjuvant chemotherapy in breast cancer patients.  Cancer. 1990;  65 847-850
• 30 Upponi S S, Ahmad F, Whitaker I S, Purushotham A D. Pregnancy after breast cancer.  Eur J Cancer. 2003;  39 736-741
• 31 Velentgas P, Daling J R, Malone K E, Weiss N S, Williams M A, Self S G, Mueller B A. Pregnancy after breast carcinoma: outcomes and influence on mortality.  Cancer. 1999;  85 2424-2432
• 32 von Schoultz E, Johansson H, Wilking N, Rutqvist L E. Influence of prior and subsequent pregnancy on breast cancer prognosis.  J Clin Oncol. 1995;  13 430-434