Balancing Decisions Around Breast Cancer Treatment and Fertility, Breastfeeding

Women diagnosed with breast cancer, especially those with a BRCA mutation, face complex decisions that extend beyond immediate treatment, such as future fertility and the possibility of breastfeeding, an expert said.

For BRCA carriers, the risk for developing cancer in the opposite breast is significantly elevated. This often leads to discussions about prophylactic mastectomy. However, for women who hope to have children and breastfeed, preserving breast tissue becomes a priority.

CURE spoke with Dr. Ann H. Partridge at the recent 2024 ESMO Congress to learn more about the conversations to have around future fertility and breastfeeding at the time of diagnosis. Partridge is interim chair of the Department of Medical Oncology, director of the Adult Survivorship Program and co-founder and director of the Program for Young Adults with Breast Cancer at Dana-Farber Cancer Institute in Boston.

Transcript:

So when we think about the idea of having a pregnancy and then nursing a baby, if one is able to become pregnant after breast cancer, this is really something that, particularly for a BRCA carrier, you want to think about at diagnosis. Because those women are often making decisions at diagnosis around not only the treatment of the breast where they have the cancer, but whether or not it makes sense to have a contralateral prophylactic mastectomy, because our BRCA carrier patients have a much higher risk of developing a new cancer in the other breast over the next five to 10 years.

And so whenever I'm speaking with a patient like that, and I know she's interested in future fertility, and she says I want bilateral mastectomy, which is kind of the knee-jerk appropriate response to someone who has very high risk, you say, "Well, are you sure you want to do that? Because you might want to nurse a child. I know you're interested in future fertility. If you do get pregnant, you might want to nurse that baby for the benefits to the baby and potential benefits for you independent of the breast cancer, the losing weight after the baby and things like that."

And so we have that conversation, and then you really tailor their local therapy to what they want to do about that. Some will want to preserve their breasts during that time and may do bilateral mastectomy later. And in the meantime, during their early survivorship, you'll do mammograms and MRIs. Some women want the bilateral mastectomy, and then they'll feed their babies in other ways.

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