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The impact of pregnancy on breast cancer survival in women who carry a BRCA1 or BRCA2 mutation

  • Epidemiology
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Abstract

Physicians are often approached by young women with a BRCA mutation and a recent history of breast cancer who wish to have a baby. They wish to know if pregnancy impacts upon their future risks of cancer recurrence and survival. To date, there is little information on the survival experience of women who carry a mutation in one of the BRCA genes and who become pregnant. From an international multi-center cohort study of 12,084 women with a BRCA1 or BRCA2 mutation, we identified 128 case subjects who were diagnosed with breast cancer while pregnant or who became pregnant after a diagnosis of breast cancer. These women were age-matched to 269 mutation carriers with breast cancer who did not become pregnant (controls). Subjects were followed from the date of breast cancer diagnosis until the date of last follow-up or death from breast cancer. The Kaplan–Meier method was used to estimate 15-year survival rates. The hazard ratio for survival associated with pregnancy was calculated using a left-truncated Cox proportional hazard model, adjusting for other prognostic factors. Among women who were diagnosed with breast cancer when pregnant or who became pregnant thereafter, the 15-year survival rate was 91.5 %, compared to a survival of 88.6 % for women who did not become pregnant (adjusted hazard ratio = 0.76; 95 % CI 0.31–1.91; p = 0.56). Pregnancy concurrent with or after a diagnosis of breast cancer does not appear to adversely affect survival among BRCA1/2 mutation carriers.

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Acknowledgments

The authors would like to acknowledge the study coordinators, Roxana Bucur Marcia Llacuachaqui, Alejandra Ragone, Jennifer Ng, Sara Elmi and Linda Steele. Supported by the Canadian Breast Cancer Foundation and the Women’s College Hospital. Also supported by NIH RO1CA74415 (S.L.N.) and P30 CA033752. S.L.N. is the Morris and Horowitz Families Endowed Professor. Recruitment of cases from the City of Hope Clinical Cancer Genetics Community Research Network is supported by Award Number RC4A153828 (PI: J.W.) from the National Cancer Institute and the Office of the Director, National Institutes of Health. The study conducted complies with the current laws of the country in which they were performed.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Women’s College Research Institute, Toronto, ON, Canada

    Adriana Valentini, Aletta Poll, Ping Sun & Steven A. Narod

  2. Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland

    Jan Lubinski & Tomasz Byrski

  3. Epidemiology Research Unit, Research Center of the University of Montreal Hospital Centre (CRCHUM), Montreal, QC, Canada

    Parviz Ghadirian

  4. Research Group on Inherited Cancer, Department of Medical Genetics, Oslo University Hospital, Radiumhosptialet, Norway

    Pal Moller

  5. Department of Preventive Medicine and Public Health, Creighton University School of Medicine, Omaha, NE, USA

    Henry T. Lynch

  6. London Regional Cancer Program, London, ON, Canada

    Peter Ainsworth

  7. Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA

    Susan L. Neuhausen

  8. City of Hope National Medical Center, Duarte, CA, USA

    Jeffrey Weitzel

  9. Department of Obstetrics and Gynaecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

    Christian F. Singer

  10. Center for Clinical Cancer Genetics, University of Chicago, Chicago, IL, USA

    Olufunmilayo I. Olopade

  11. Hereditary Cancer Program, Division of Human Genetics, Children’s Hospital Medical Center, Cincinnati, OH, USA

    Howard Saal

  12. Service de Génétique Oncologique, Institut Curie Hôpital, Institut Curie Centre de Recherche, Paris, France

    Dominique Stoppa Lyonnet

  13. Department of Medical Genetics, McGill University, Montreal, QC, Canada

    William D. Foulkes

  14. BC Cancer Agency, Vancouver, BC, Canada

    Charmaine Kim-Sing

  15. Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Siranoush Manoukian

  16. Cancer Genetics Program, Beaumont Hospital, Royal Oak, MI, USA

    Dana Zakalik

  17. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada

    Susan Armel

  18. Division of Human Genetics, The Ohio State University Medical Center, Columbus, OH, USA

    Leigha Senter

  19. Genomic Medicine Institute and Center for Personalized Genetic Healthcare, Cleveland Clinic, Cleveland, OH, USA

    Charis Eng

  20. Department of Genetics and Genome Sciences and Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA

    Charis Eng

  21. Department of Family and Community Medicine, University of Toronto, Toronto, ON, USA

    Eva Grunfeld

  22. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, USA

    Anna M. Chiarelli & Steven A. Narod

  23. Cancer Care Ontario, Toronto, ON, USA

    Anna M. Chiarelli

  24. Women’s College Research Institute, 790 Bay Street, Room 750, Toronto, ON, M5G 1N8, Canada

    Steven A. Narod

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  1. Adriana Valentini
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The Hereditary Breast Cancer Clinical Study Group

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Correspondence to Steven A. Narod.

Additional information

The other members of the Hereditary Breast Cancer Clinical Study Group are given in Appendix.

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10549_2013_2729_MOESM1_ESM.doc

Fig 4 (supplemental) Breast cancer-specific survival for subjects with and without a pregnancy: from ascertainment (DOC 25 kb)

10549_2013_2729_MOESM2_ESM.doc

Fig 5 (supplemental) Recurrence-free survival in subjects with and without a pregnancy after breast cancer: Follow-up from date of last birth (DOC 25 kb)

Appendix: Other members of the Hereditary Breast Cancer Clinical Study Group

Appendix: Other members of the Hereditary Breast Cancer Clinical Study Group

Jacek Gronwald, Cezary Cybulski, Tomasz Huzarski, Andre Robidoux, Kenneth Offit, Ruth Gershoni-Baruch, Claudine Isaacs, Nadine Tung, Barry Rosen, Rochelle Demsky, Jeanna McCuaig, Andrea Eisen, Louise Bordeleau, Beth Karlan, Judy Garber, Dawna Gilchrist, Charis Eng, Fergus Couch, Gareth Evans, Ava Kwong, Lovise Maehle, Eitan Friedman, Wendy McKinnon, Marie Wood, Mary Daly, Joanne L. Blum, Mark Robson, Albert Chudley, Seema Panchal, Jane McLennan, Barabara Pasini, Gad Rennert, John Lunn, Taya Fallen, Daniel Rayson, Marissa Smith, Ophira Ginsburg, Edmond Lemire, Wendy Meschino, Tuya Pal, Susan Vadaparampil, David Euhus, Josephine Wagner Costalas, Talia Donenberg, Raluca N. Kurz, Susan Friedman (on behalf of FORCE), Kevin Sweet, Carey A. Cullinane, Robert E. Reilly, Joanne Kotsopoulos, Sonia Nanda, Kelly Metcalfe.

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Valentini, A., Lubinski, J., Byrski, T. et al. The impact of pregnancy on breast cancer survival in women who carry a BRCA1 or BRCA2 mutation. Breast Cancer Res Treat 142, 177–185 (2013). https://doi.org/10.1007/s10549-013-2729-1

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