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Does pregnancy affect breast cancer risk and survival?

wmanning — Sat, 19 Oct 2019 18:32:55 +0000

Pregnancy and breast cancer impact each other in many ways. Whether you are cancer-free, newly diagnosed or a long-term survivor, you may have questions about how having children and breast cancer may be related. Understanding how childbearing impacts your breast cancer risk, and for survivors, how it relates to the chances of survival after treatment is important. And, for newly diagnosed younger women, understanding how some therapies may affect your fertility may be helpful in exploring options for having a child after treatment ends.

Pregnancy and breast cancer risk

Pregnancy is a time of breast development and hormone changes, so it is not surprising that it affects your breast cancer risk. However, this relationship is complex. Both the age when you give birth to your first child and the number of children you give birth to affect your risk.

How does age at the birth of a first child affect your breast cancer risk?

Although a first pregnancy may increase the short-term risk of breast cancer, it lowers the long-term risk. Pregnancy’s effects depend on your age when you first give birth.^1-3

Women who have their first child at age 35 or younger tend to get an overall protective benefit from pregnancy. Breast cancer risk is slightly increased for about 10 years after a first birth. After that, it drops below the risk of women who don’t have children. The younger you are when you have your first child, the sooner you get the risk reduction benefit.^2-3

Women who have their first child at later ages are at an increased risk of breast cancer compared to women who have their first child at younger ages.^2-3 For example, women who give birth for the first time after age 35 are 40 percent more likely to get breast cancer than women who have their first child before age 20.⁴ For women who give birth at older ages, the increase in risk from a first pregnancy never gets fully offset by its long-term protective benefits.^2-3

Why does age at first birth matter?

The different effects of age at first childbirth on breast cancer risk may be related to breast cells. During pregnancy, breast cells grow rapidly. If there is any genetic damage in the breast cells, it gets copied as the cells grow. This increased genetic damage in the cells can lead to breast cancer. And, the chance of having such genetic damage goes up with age. This may explain why women who have their first child at a later age have a higher risk of breast cancer than women who have their first child at a younger age.^1,3

How does childbearing affect your breast cancer risk?

The more children a woman has given birth to, the lower her risk of breast cancer tends to be. After a first child, each childbirth lowers risk.³ The exact reasons behind this link are unclear at this time.

Women who have never given birth (called nulliparous) have a slightly higher risk of breast cancer compared to women who have had more than one child.³ However, women who give birth only once at age 35 or older have a slightly higher risk compared to nulliparous women. This is because the excess risk of having only one child at an older age never quite goes away.^2-3

Whether having children protects equally against estrogen receptor-positive and estrogen receptor-negative (including triple negative) breast cancers is under study.⁵ Learn more about triple negative breast cancers.

Breastfeeding and breast cancer risk

Breastfeeding lowers the risk of breast cancer and has other health benefits for mothers and infants.^6-7The longer a woman breastfeeds (the combined time of breastfeeding for all children), the greater the protective benefit for breast cancer risk tends to be (learn more).⁶

Breast cancer during pregnancy

A breast cancer diagnosis during pregnancy is rare. However, when it does happen, it can be safely and successfully treated (learn more).

If you have concerns about changes in your breasts while you are pregnant or breastfeeding, talk to your health care provider.

Pregnancy and breast cancer survival

Having a child after treatment for breast cancer appears to be safe for women.^8-11 If you are a survivor and are considering becoming pregnant, talk to your health care provider about the best timing of a pregnancy based on your treatment and cancer.

Pregnancy does not appear to lower a woman’s chances for long-term survival after breast cancer.^8-11 In fact, a meta-analysis that combined the results from 14 studies found women who had a child after breast cancer treatment had better overall survival than women who did not have a child after treatment.¹⁰

Although having a child after treatment does not have a negative impact on survival, not all women may get a survival benefit. Women who become pregnant after treatment ends may be healthier than those who do not. Thus, the survival benefit found in studies may be due to the fact that only healthier women pursued pregnancy.¹⁰ Learn more about findings from studies on pregnancy after breast cancer treatment and survival.

Breast cancer treatment and fertility

Some treatments for breast cancer can impact fertility. Both chemotherapy and tamoxifen can cause menopause or bring on natural menopause earlier than normal (some types of chemotherapy are more likely than others to cause early menopause). Tamoxifen (generally given for five years) can also shorten the window of time to have children.^12-14 Taking tamoxifen during pregnancy can harm the fetus, so women should wait until tamoxifen treatment is completed before becoming pregnant.¹⁴

If you wish to have a child after breast cancer treatment, talk to your health care provider (and if possible, a fertility specialist) before you begin treatment to discuss your options. Meeting with a fertility specialist as early as possible (before surgery) offers the widest range of options.¹²

Preserving fertility during breast cancer treatment

There are a few steps you can take before and during treatment to increase your chances of having a child after your breast cancer treatment.

Storing embryos

Before breast cancer treatment begins, you may store fertilized embryos. In this procedure, eggs are collected over a number of menstrual cycles, then fertilized and frozen. After treatment, the embryos can be thawed and implanted into the uterus. This procedure has a good rate of success, but it also has some down sides. Treatment may be delayed while eggs are collected, and a sperm donor is needed to fertilize the eggs before they are stored.^15-16

Unfertilized eggs (which do not require a sperm donor) can also be frozen and stored. However, this method is much less successful than using fertilized eggs and is still considered experimental.¹⁶

Protecting the ovaries during chemotherapy

Chemotherapy attacks fast-growing cells (not only cancer cells but also cells in other parts of the body, like the ovaries). Drugs like goserelin (Zoladex), leuprolide (Lupron) and triptorelin can shut down the ovaries during chemotherapy, which may protect them from damage and lower the chances of early menopause.¹⁷ More studies are needed to know whether these drugs affect prognosis.^15-16

Summary

According to Ann Partridge, MD, MPH, Clinical Director of the Breast Oncology Center at Dana-Farber Cancer Institute and Associate Professor of Medicine at Harvard Medical School “the relationships between breast cancer risks and reproductive health are quite complex and the subject of intensive prior and ongoing research. Continuing to improve our understanding of these relationships is critical to the health and well-being of breast cancer survivors and women at risk for breast cancer. ”

To summarize:

Having children can lower breast cancer risk, especially for younger women. The more children a woman gives birth to, the lower her risk of breast cancer.
However, having one child at a later age can slightly increase risk.^2-4
Having a child after breast cancer treatment does not worsen survival.
Women diagnosed with breast cancer who want to have a child after treatment should talk to a fertility specialist as early as possible, ideally before treatment begins. Even if you choose not to take one of the steps available, exploring all of your options may help you feel more comfortable with your choices later in life.¹⁸

References

1. Lambe M, Hsieh C, Trichopoulos D, Ekbom A, Pavia M, Adami HO. Transient increase in the risk of breast cancer after giving birth. N Engl J Med. 331(1):5-9, 1994.

2. Colditz GA, Rosner B. Cumulative risk of breast cancer to age 70 years according to risk factor status: data from the Nurses’ Health Study. Am J Epidemiol. 152(10):950-64, 2000.

3. Willett WC, Tamimi RM, Hankinson SE, Hunter DJ, Colditz GA. Chapter 20: Nongenetic Factors in the Causation of Breast Cancer, in Harris JR, Lippman ME, Morrow M, Osborne CK. Diseases of the Breast, 4th edition, Lippincott Williams & Wilkins, 2010.

4. Ewertz M, Duffy SW, Adami HO, et al. Age at first birth, parity and risk of breast cancer: a meta-analysis of 8 studies from the Nordic countries. Int J Cancer. 46(4):597-603, 1990.

5. Shinde SS, Forman MR, Kuerer HM, et al. Higher parity and shorter breastfeeding duration: association with triple-negative phenotype of breast cancer. Cancer. 116(21):4933-43, 2010.

6. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breast feeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50,302 women with breast cancer and 96,973 women without the disease. Lancet 20:187-195, 2002.

7. Ip S, Chung M, Raman G, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: US Department of Health and Human Services. http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf, 2007.

8. Mueller BA, Simon MS, Deapen D, et al. Childbearing and survival after breast carcinoma in young women. Cancer. 98(6): 1131-40, 2003.

9. Kroman N, Jensen MB, Wohlfahrt J, Ejlertsen B. Pregnancy after treatment of breast cancer–a population-based study on behalf of Danish Breast Cancer Cooperative Group. Acta Oncol. 47(4):545-9, 2008.

10. Azim HA Jr, Santoro L, Pavlidis N, et al. Safety of pregnancy following breast cancer diagnosis: a meta-analysis of 14 studies. Eur J Cancer. 47(1):74-83, 2011.

11. Valachis A, Tsali L, Pesce LL, et al. Safety of pregnancy after primary breast carcinoma in young women: a meta-analysis to overcome bias of healthy mother effect studies. Obstet Gynecol Surv. 65(12):786-93, 2010.

12. Lee S, Ozkavukcu S, Heytens E, Moy F, Oktay K. Value of early referral to fertility preservation in young women with breast cancer. J Clin Oncol. 28(31):4683-6, 2010.

13. Partridge AH and Ginsburg ES. Chapter 96: Reproductive Issues in Breast Cancer Survivors, in Harris JR, Lippman ME, Morrow M, Osborne CK. Diseases of the Breast, 4th edition, Lippincott Williams & Wilkins, 2010.

14. National Comprehensive Cancer Network. NCCN Clinical practices guidelines in oncology: Breast cancer. V.2.2011. http://www.nccn.org, 2011.

15. Jeruss JS, Woodruff TK. Preservation of fertility in patients with cancer. N Engl J Med. 360(9):902-11, 2009.

16. Hulvat MC, Jeruss JS. Fertility preservation options for young women with breast cancer. Curr Opin Obstet Gynecol. 23(3):174-82, 2011.

17. Lucia Del Mastro, Luca Boni, Andrea Michelotti, et al. Effect of the gonadotropin-releasing hormone analogue triptorelin on the occurrence of chemotherapy-induced early menopause in premenopausal women with breast cancer: a randomized trial. JAMA. 306(3):269-276, 2011.

18. Letourneau JM, Ebbel EE, Katz PP, et al. Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer. Cancer. 2011 Sep 1 [Epub ahead of print].

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Cooking Up Gifts for Mom’s Kitchen

wmanning — Thu, 21 Apr 2016 13:54:13 +0000

From homemade childhood favorites that warm the heart to delectable desserts, no one works their magic in the kitchen quite like mom. When trying to decide what to get your favorite lady for Mother’s Day this year, look for gifts that allow her to channel her inner foodie, chef or baker.

The best gifts are always those that keep on giving. Through Cook for the Cure, a 15-year partnership between KitchenAid and Susan G. Komen, more than $10.7 million has been raised for the fight against breast cancer. In 2016, KitchenAid will donate at least $450,000 to Komen through the program, regardless of sales. The Cook for the Cure product collection, ranging from pink stand mixers and polka dot bowls to pink food choppers, painted plates and hand mixers, is an easy way to give thanks to mom and raise awareness for a cause that benefits so many women.

For other gift ideas that help support the cause, visit www.KitchenAid.com and http://CookfortheCure.KitchenAid.com.

An Essential, Everyday Tool

If some of her best culinary creations include savory sauces, delightful dressings and delicious dips, Mother’s Day is the perfect opportunity to treat mom to an upgrade. This 3.5-cup Food Chopper in Pink is convenient for everyday use and takes up minimal space in the kitchen. With two one-touch speed settings for chop and puree, this chopper ($49.99) is ideal for creating a spicy salsa, creamy hummus or garden-fresh pesto.

Blending Style with Power

With its roomy, 60-ounce patented diamond pitcher design and stainless steel blades, the 5-Speed Diamond Blender in Cranberry creates a powerful vortex to thoroughly blend everything from soups to smoothies. Automatic Soft Start(r) technology pulls ingredients into the blade rather than splattering them outward, keeping them together for controlled blending. This colorful blender ($159.99) offers stir, chop, mix, puree, liquefy and pulse options – everything mom needs to create her favorite dishes.

Handy Little Helper

Whether you need to blend up a milkshake or puree cooked vegetables directly in the pot, this 2-Speed Hand Blender in Pink gets the job done with ease. Two speeds provide blending control for more delicate foods, such as smoothies and baby food. The blending arm twists off for quick and easy cleanup. This hand blender ($59.99) comes with a 3-cup BPA-free jar with lid, so mom can blend away, safely.

Plated Perfection

Featuring artwork by PBS cooking show host Jacques Pepin, the Pass the Plate serving platter generates a $5 donation each time one of these individually numbered platters is passed and registered online. With its fresh and cheery design, this unique serving piece makes sharing even more fun. A great gift for mom, the platter ($24.95) is available at Villeroy & Boch stores or by calling 1-888-886-8318.

Mix in Some Style

Turn Mom’s stand mixer into a standalone work of art this Mother’s Day with the new Pink Polka Dot ceramic bowl. This delightfully dappled 5-quart bowl ($99.99) is microwave, oven, freezer and dishwasher safe, and features a comfortable handle and easy pour spout – a perfect pick for all of mom’s mixing tasks.

Timeless Kitchen Addition

Add a pop of pink to mom’s kitchen with a classic gift that will endure for years. With an elegant 5-quart capacity glass bowl, the Artisan Design(r) Series’ premium metallic Raspberry Ice finish adds radiance to any kitchen countertop. It can handle multiple batches of dough while its 10 speed settings allow cooks to knead, mix and whip a variety of foods and ingredients. With additional attachments that can make everything from pasta to ice cream to spiralized fruits and vegetables, this mixer ($459.99) helps mom take her culinary creativity to a whole new level.

Photo courtesy of Getty Images (women exchanging gifts)
#13181
Source: KitchenAid

*FF

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Breast Cancer in 2013: What You Need to Know

wmanning — Fri, 20 Sep 2013 16:00:55 +0000

Thirty years ago, a diagnosis of breast cancer was thought of as a virtual death sentence for many women, but since that time significant progress has been made in the fight against breast cancer. Reduced mortality, less invasive treatments, an increased number of survivors and other advancements have their roots in breast cancer research – more than $790 million of it funded by Susan G. Komen, the world’s largest breast cancer organization.

However, the reality is that breast cancer is still a serious disease. National Breast Cancer Awareness Month, held each October, brings awareness to the disease and empowers women to take charge of their own breast health.

This year, about 200,000 new cases of invasive breast cancer will be diagnosed among women in the U.S. and nearly 40,000 women will die from it. Globally, 1.6 million people will be diagnosed, and 400,000 will die. Despite the increased awareness of breast cancer, major myths still abound. Women must remain vigilant against this disease by learning the facts and understanding how they may be able to reduce their risk.

The Myths and Facts on Breast Cancer

Myth: I’m only 35. Breast cancer happens only in older women.

Fact: While the risk increases with age, all women are at risk for getting breast cancer.

Myth: Only women with a family history of breast cancer get the disease.

Fact: Most women who get breast cancer have no family history of the disease. However, a woman whose mother, sister or daughter had breast cancer has an increased risk.

Myth: If I don’t have a mutated BRCA1 or BRCA2 gene, I won’t get breast cancer.

Fact: You can still get breast cancer, even without a gene mutation. About 90 to 95 percent of women who get breast cancer do not have this mutation.

Myth: Women with more than one known risk factor get breast cancer.

Fact: Most women with breast cancer have no known risk factors except being a woman and getting older. All women are at risk.

Myth: You can prevent breast cancer.

Fact: Because the causes of breast cancer are not yet fully known, there is no way to prevent it.

Actions to Reduce Your Risk

Breast cancer can’t be prevented; however, research has shown that there are actions women can take to reduce their risk of developing breast cancer.

Maintain a Healthy Weight – Postmenopausal women who are overweight have a 30 to 60 percent higher breast cancer risk than those who are lean.
Add Exercise into Your Routine – Women who get regular physical activity may have a lower risk of breast cancer by about 10 to 20 percent, particularly in postmenopausal women.
Limit Alcohol Intake – Research has found that women who had two to three alcoholic drinks per day had a 20 percent higher risk of breast cancer.
Breastfeed, if you can – Research has shown that mothers who breastfed for a lifetime total of one year (combined duration of breastfeeding for all children) were slightly less likely to get breast cancer than those who never breastfed.

For more information on the facts about breast cancer and what you need to reduce your risk, or to find resources in your community, visit Komen.org or call 1-877-GO-KOMEN.

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31 Days of Impact

wmanning — Fri, 19 Oct 2012 19:00:22 +0000

Jamie Ledezma, Fresno, California – Breast Cancer Survivor, Advocate

“The moment the words “You have cancer” were said, I took out my pen and pad and started asking questions. I was on a mission to get information, to make sure my baby would be born healthy and happy.”

“I got involved with Komen because they are on the front lines advocating for the most important issues for survivors like me – in states like California, for instance, many women rely on the state’s screening program, which ensures that a lost job or lost insurance doesn’t result in a lost life.”

“Komen’s California Affiliates are actively lobbying to sustain funding for specific programs that will make sure underserved women have access to screening and early detection of breast cancer.”

My husband and I got to hear our baby’s heartbeat for the first time at a routine doctor’s appointment in February of 2007. Everything checked out and looked great until my doctor asked whether I had any questions. “As a matter of fact, I do,” I replied. “What is this lump? Is it a milk gland, already?”

On Valentine’s Day, our worst fears were confirmed: I had triple-negative breast cancer. I was 14 weeks pregnant and 27 years old. On that day, every goal and timeline I had carefully mapped out for our family and my career were thrown out the window. Now my focus was only on the fight to make sure my baby would be born both healthy and happy; my own health and survival were secondary. One week after my diagnosis I began chemotherapy. My oncologist prescribed a cocktail of medications that were known to be safe for the fetus because the drugs didn’t pass the placental barrier. But that reassurance was difficult to grasp while sitting in an infusion chair for six hours.

I also had to deal with so many unexpected issues: disability and life insurance, pre-existing conditions, the lifetime and annual limits of health insurance policies, and coverage appeals. As a former insurance defense attorney, I was better equipped to handle these than the dozens of other young cancer patients I met, such as the single mom who lost her job at a gas station because of her treatment schedule, and the couple who lost their home because of crushing medical costs.

Our baby had nearly six months of chemotherapy with me before his early arrival on July 14, 2007. Blake was born at a healthy 5 pounds, 9 ounces, and with a full head of hair – more than I had, at the time, because of the drugs! A week after his delivery, I returned to my aggressive chemotherapy schedule for another three months. After that came a bilateral mastectomy and a series of six reconstructive and prophylactic surgeries.

When Blake was five months old, I returned to work. I felt as though I had left work on cancer’s terms, and I wanted to go back to work on my terms – and that meant as soon as possible, even though I still wore a wig, faced major surgeries, and had an infant at home.

As part of my continuing education requirements for my license, I attended a cancer rights conference. Sitting there talking with 200 other attorneys, advocates, patients, and healthcare providers, I realized that I could become a cancer rights attorney, coupling my professional experience as a lawyer with my personal passion for helping others who struggle with cancer.

Now I work as a cancer rights attorney at the Cancer Legal Resource Center and seize every opportunity to educate others by sharing my experience as a young breast cancer survivor. I also proudly serve as the Past-Chair of Public Policy Chair for the California Collaborative of Susan G. Komen for the Cure, as a member of the Susan G. Komen for the Cure National Public Policy Advisory Council and was recently appointed to the California Breast and Cervical Cancer Advisory Council for the State of California to help ensure underserved women have access to life-saving early detection services.

Today, Blake is a healthy, vibrant five-year-old and a constant reminder about what is truly important to me.

http://ww5.komen.org/impact.html

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