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Topic: Having a baby post TNBC treatment... to do or not to do

Forum: Young With Breast Cancer —

Connect with those under 40 who have been diagnosed.

Posted on: May 20, 2016 07:46PM

smeeks wrote:

Hello all!

I am hoping that someone may have experience or knowledge about this topic as I am not able to find a lot of good information regarding having a baby post cancer treatment for TNBC. My husband and I are on the fence about having another baby and I feel like the more information we can obtain the better we will feel about our decision either way. I will try to keep this short but want to be sure to include all the important points. Thanks in advance for any thoughts, information, and tid bits you may be able to pass along! :)

I was 32 yo when diagnosed with Stage 2 triple negative breast cancer last year following the conclusion of breastfeeding my then 20 month old daughter (she hung onto some night feedings making finding the lump sooner impossible). Once diagnosed, I underwent chemotherapy first (AC and then Carbo/Taxol) for 6 months. At the beginning of chemo I also started to get monthly Zoladex injections to "properly" shut down my ovaries in hopes to preserve my fertility. I did not harvest eggs prior to treatment starting. Everything I have been told by my oncologist and OB/GYN is that due to my cancer being non-hormone driven, there is not an increased risk to have subsequent children. Due to being TN I am not needing to take ongoing medications which would eliminate my window to have children as well. While TNBC is not hormone driven I have been told and read that it is more common in pregnant and postpartum women so I do wonder what another pregnancy may trigger (?). I completed chemo, double mastectomy (complete pathological response shown in pathology- lymph nodes removed) and competed 25 radiation treatments. I tested negative for BRCA and other tested genetic markers.

I am unable to find a lot of information in books and online that could discuss this topic further (most just say to ask your doctor) so I thought I would throw this question to others...

-Have you had a child post-treatment for TNBC? What was your experience like?

- If so (or if decided not to), what were you advised by your oncologists and OB/GYNs on the matter? What was your leading deciding factor?

My husband and I are both unsure about this for many reasons at this time. Our daughter is a sweet and sassy 3yo now, I will be 34yo when I am 1 year post chemo (when I will be able to safely try for another child per my oncologist), and my husband will be 38yo. We always planned to have two children, but I did not anticipate having cancer at the age of 32, and I feel like that may have changed some of our thoughts, priorities, and goals. My daughter was my best medicine through treatment and I just feel so blessed to have her at all. I feel like I need to use this time to collect as much information as I can so we can best make the decision we feel most comfortable with. If you have read all this, thank you! :) I appreciate any and all thoughts on the matter.

Thanks,

Stacey Log in to post a reply

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May 22, 2016 05:53PM - edited May 22, 2016 05:55PM by Tmh0921

Stacey,

I was 27 when I was Dx back in 1999. My cancer was ER+/PR+, so I can't speak to the triple negative aspect.

We were just starting to "try" to get pregnant when I was Dx. We had to put that on hold for treatment, etc. At two years post Dx and I opted to stop Tamoxifen and try for a baby. At the time, they really didn't encourage pregnancy post BC, and they didn't offer the fertility options they do today. I had long conversations with my oncologist, surgeon, and OB/GYN about it, and ultimately decided to go for it.


When I told my oncologist that I was pregnant he sat me down and took my hand and told me to enjoy my pregnancy and my baby. He told me to never regret my decision, that whatever happened with regards to my cancer would happen regardless of pregnancy (pregnancy doesn't CAUSE recurrence).


There have been studies since that have shown pregnancy doesn't increase risk of recurrence.


I am happy to say that I've had two babies after breast cancer, who are now 13 & 8. I was followed closely by my treatment team during both pregnancies but had no issues or complications relating to cancer.


Tracy

First Dx at 27 years old in 1999, 2nd Dx 2018, 3rd Dx 2019... Current Oncotype: 26 Dx 12/7/1999, IDC, Left, 1cm, Stage IB, Grade 2, 0/15 nodes, ER+/PR+ Surgery 12/22/1999 Lumpectomy: Left; Lymph node removal: Left, Sentinel, Underarm/Axillary Radiation Therapy 1/31/2000 Whole-breast: Breast, Lymph nodes Hormonal Therapy 2/1/2000 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 8/24/2016 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 9/5/2018 Lumpectomy: Left Dx 9/7/2018, DCIS, Left, <1cm, Stage 0, Grade 1 Dx 5/31/2019, IDC, Left, 3cm, Stage IIA, Grade 3, 0/2 nodes, ER+/PR+, HER2- (IHC) Surgery 8/5/2019 Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Latissimus dorsi flap, Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 9/4/2019 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 12/2/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone), Zoladex (goserelin) Hormonal Therapy 3/24/2020 Femara (letrozole), Zoladex (goserelin) Surgery 7/16/2020 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Sep 28, 2016 12:47AM LillieRose wrote:

Any update on this post?!? I'm about 15 months post chemo... I have stage 2 TNBC and was diagnosed when my daughter was 5 months old... I was 30 at the time. I can't seem to find any info on this and my Onc isn't very helpful... I want another baby so bad but I'm scared that the pregnancy may have triggered the cancer. It is such a grey subject! Any info you have would be amazing! Thank you

Dx 3/31/2015, IDC, 2cm, Stage IIA, Grade 3, 0/4 nodes, ER-/PR-, HER2-
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Sep 28, 2016 01:32AM - edited Sep 28, 2016 01:46AM by stephincanada

Hi LillieRose,

For what it is worth, I saw a gynaecologist who told me that in women who have triple negative BC, having ovaries removed improves overall survival. (I was consulting with her because I am thinking about having my ovaries removed--my cancer is ER/PR negative.) She said that we don't know exactly what the relationship is between hormones and breast cancer, but there seems to be a link between estrogen and breast cancer, even if the BC is hormone receptor negative. I haven't seen the study and don't know if it was based on a large population or if it is a good quality study, but thought I'd put it out there for you to do further research. Please also keep in mind that the doctor who shared this information with me is not an oncologist. I would be curious to see what a medical oncologist has to say about this theory.

Best wishes in making this important decision,

Stephanie

Dx 5/26/2016, IDC, Right, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2+ (IHC) Surgery 6/7/2016 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 7/7/2016 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Targeted Therapy 9/6/2016 Herceptin (trastuzumab) Targeted Therapy 9/7/2016 Perjeta (pertuzumab) Radiation Therapy 11/29/2016 Whole-breast: Breast, Lymph nodes
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Sep 28, 2016 01:45AM - edited Sep 28, 2016 03:20AM by stephincanada

Lillierose,

I just did a search on pubmed using the search terms "triple negative breast cancer oophorectomy".

Here are some studies to which the gynaecologist I mentioned in my previous post might have referred:

https://www.ncbi.nlm.nih.gov/pubmed/20935677

"It is prevailingly thought that estrogen signaling is not involved in development of estrogen receptor (ER)- negative breast cancer. However, there is evidence indicating that ovariectomy prevents the development of both ER-positive and -negative breast cancer, suggesting that estrogen signaling is involved in the development of ER-negative breast cancer."

And here is the second relevant one:

https://www.ncbi.nlm.nih.gov/pubmed/26411365
Here is the one sentence I was able to understand from the abstract Winking : "Using a TN (triple negative) experimental metastases model, we demonstrate that ovariectomy decreased the frequency of magnetic resonance imaging-detectable (brain) lesions by 56% as compared with estrogen supplementation, and that the combination of ovariectomy and letrozole (an aromatase inhibitor) further reduced the frequency of large lesions to 14.4% of the estrogen control."

Again, I have no idea if these studies are persuasive or not. Just wanted to bring them to your attention...

Also, have you thought about using a surrogate?

Stephanie

Dx 5/26/2016, IDC, Right, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2+ (IHC) Surgery 6/7/2016 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 7/7/2016 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Targeted Therapy 9/6/2016 Herceptin (trastuzumab) Targeted Therapy 9/7/2016 Perjeta (pertuzumab) Radiation Therapy 11/29/2016 Whole-breast: Breast, Lymph nodes
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Oct 18, 2016 05:04PM LillieRose wrote:

Thank for you taking the time to respond! I've never heard any mention about having my ovaries removed... I live in Boston and saw two of the top Onc here who told me after I had my BMX that no more treatment or surgery was necessary. I lot off TNs seem to be BRAC+ so maybe the article I sure refering them.... it is def something i plan to bring up at my next appointment! Thank you for sharing for sharing

Dx 3/31/2015, IDC, 2cm, Stage IIA, Grade 3, 0/4 nodes, ER-/PR-, HER2-
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Oct 19, 2016 03:14AM stephincanada wrote:

hi Lillierose,

http://www.breastcancer.org/tips/fert_preg_adopt/a...

I happened to come across this article on the "ask the experts" section of the main Breastcancer.org website. There were other articles on the pregnancy after treatment topic. So, there is much more relevant information thank provided previously. Just enter the word "pregnancy" in the search box of the main website (not the "community" section.)

Best,

Stephanie

Dx 5/26/2016, IDC, Right, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2+ (IHC) Surgery 6/7/2016 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 7/7/2016 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Targeted Therapy 9/6/2016 Herceptin (trastuzumab) Targeted Therapy 9/7/2016 Perjeta (pertuzumab) Radiation Therapy 11/29/2016 Whole-breast: Breast, Lymph nodes

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