Angela Ives

Pregnancy after breast cancer: population based study.

Objectives To identify women who survived breast cancer and subsequently conceived and to determine the rate of pregnancy (proportion), management, outcome of the cancer, and outcome of the first subsequent pregnancy. Design Population based descriptive study with cases identified from the Western Australian data linkage system and validated by review of medical charts. Supplementary data obtained from hospital and clinician records. Setting Western Australia, 1982-2003. Participants Women aged <45 with a diagnosis of breast cancer who subsequently conceived. Main outcome measures Pregnancy outcome and rate, survival, time from diagnosis to pregnancy. Results Sixty two (54%) women with a diagnosis of breast cancer who subsequently conceived did so less than two years after their diagnosis: 29 of them had an abortion, 27 had a live birth, and six miscarried. Within a proportional hazards regression model subsequent pregnancy was associated with improved overall survival (hazard ratio 0.59, 95% confidence interval 0.37 to 0.95). When the model was stratified by time from diagnosis subsequent pregnancy was associated with improved overall survival in women who waited at least 24 months to conceive (0.48, 0.27 to 0.83) and a non-significant protective effect was seen for women who waited at least six months to become pregnant. Conclusions Our study does not support the current medical advice given to premenopausal women with a diagnosis of with breast cancer to wait two years before attempting to conceive. This recommendation may be valid for women who are receiving treatment or have systemic disease at diagnosis, but for women with localised disease early conception, six months after completing their treatment, is unlikely to reduce survival.

Reducing delay in the diagnosis of pregnancy-associated breast cancer: How imaging can help us

Introduction: The evaluation of breast symptoms during pregnancy or lactation can be challenging but prompt, appropriate assessment of symptoms may lead to earlier cancer detection.

Breast cancer and pregnancy: A diagnostic and management dilemma

Background:  The purpose of the present paper was to review the current knowledge of pregnancy concurrent with a diagnosis of breast cancer, and how best to manage this group of women and those breast cancer survivors who may subsequently conceive.

The experience of pregnancy and early motherhood in women diagnosed with gestational breast cancer

Objective: To explore the psychosocial experiences of pregnancy in women diagnosed with breast cancer during or shortly after pregnancy.

Decision making, psychological wellbeing and psychosocial outcomes for high risk women who choose to undergo bilateral prophylactic mastectomy – A review of the literature

A bilateral prophylactic, or preventative, mastectomy (BPM) for women at high risk of developing breast cancer (BC) can reduce their risk of developing the disease by up to 90% (relative risk reduction). An increasing number of women, including young women, are taking up this option. However, there is a dearth of information for younger women (under 40 years) choosing preventative mastectomy. In fact, no studies to date have specifically focused on younger womens experiences of a BPM and investigated their informational needs. The purpose of this review is to report on the current literature surrounding the psychological experience of a BPM and the informational needs for women at high risk of developing BC with a particular emphasis on younger women. Research has highlighted a range of psychological outcomes linked to preventative mastectomy, including positives such as reduced anxiety and negatives including impaired body image and sexuality. The literature strongly suggests women want more information surrounding BPM, particularly related to the after effects of the surgery, and the impact on their psychological wellbeing. Research method limitations and reporting has resulted in conflicting conclusions, making it difficult for women to be well informed. In particular, there has been little focus on the experiences and needs of younger women opting for BPM. Due to the unique needs of younger women and an increase in BPM rates for younger women, it is imperative that the needs of this group are addressed. Together these findings provide justification and recommendation for further research in this area.

Rates for mastectomy are lower in women attending a breast-screening programme

Background:  Mammographic screening for breast cancer facilitates earlier recognition of lesions, thus potentially allowing for breast‐conserving surgery. Few studies have compared the final surgical outcomes of women presenting through breast screening programmes with those presenting via other sources. Are breast cancer patients presenting through BreastScreen more likely to undergo breast‐conserving surgery than those presenting from other sources?

Pregnancy Outcomes After a Breast Cancer Diagnosis: A Systematic Review and Meta-analysis

Abstract Improvements in local and systemic treatment, along with earlier diagnoses through breast awareness and screening, have led to increases in survival and a decline in breast cancer (BC) recurrence. To the best of our knowledge, no meta‐analysis has yet focused on pregnancy outcomes after BC treatment. Hence, our research group explored the reproductive outcomes (pregnancy, miscarriage, termination of pregnancy, live births) after BC treatment. The Embase, MEDLINE, PubMed, and Scopus databases were searched. Studies were included that reported on pregnancy and reproductive outcomes after treatment of BC. A meta‐analysis of 16 studies with subgroup analyses was conducted. In the matched cohort and case‐control studies (n = 1287), subgroup analysis showed that women who had received systemic therapy after surgery had an overall pooled estimate of 14% (95% confidence interval [CI], 0.12‐0.16; I2 = 95.4%) of becoming pregnant. Of those who became pregnant, 12% (95% CI, 0.08‐0.16; I2 = 65.9%) experienced a miscarriage. For the population‐based studies (n = 711), the estimated pooled pregnancy rate was 3% (95% CI, 0.02‐0.03; I2 = 85.1%) for women who became pregnant after BC treatment. The pregnancy rate after BC treatment for survivors was on average 40% lower than the general population pregnancy rate. Women with BC should be informed about the subsequent adverse effects of BC and its treatments on conception. With the increasing trend for women to defer childbirth to later in life, provision of fertility‐related information, access to fertility preservation, and fertility‐related psychosocial support should be offered to women of a reproductive age before they begin BC treatment.

Heightened perception of breast cancer risk in young women at risk of familial breast cancer

The objective of this study was to explore the factors that influence perceived personal risk of developing breast cancer (BC) in younger women (<35) who are considering or have undergone bilateral prophylactic mastectomy (BPM). Qualitative interviews guided by interpretative phenomenological analysis were conducted with 46 women who had a strong family history of BC and had either undergone (n = 26) or were considering (n = 20) BPM. Participants were recruited from Australia and New Zealand via hospitals, a genetics clinic, a research cohort, a registry and online. Three main themes were identified: information that increases fear of BC and death, underlying anxiety and fear and screening anxiety. A further two themes: relief following surgery and confusion about residual risk following surgery were identified. Younger women (<35) appeared to have heightened and sometimes inaccurate perceptions of their BC risk. They appeared less relieved of anxiety and fear of developing BC by BPM surgery, in comparison to previous research with older women (>40). Those who had undergone BPM seemed more anxious about their risk of developing BC than those who were still considering surgery. This research has important implications for practice, particularly improving communication of accurate risk statistics. Future research should examine why some women interpret information differently and explore the benefits of psychological consultation for very anxious women.

Influences on decision-making for young women undergoing bilateral prophylactic mastectomy

OBJECTIVE The objective of this study was to explore the influences on decision-making of younger women (<35) undergoing or considering bilateral prophylactic mastectomy (BPM). METHODS Qualitative interviews guided by interpretative phenomenological analysis (IPA) were conducted with forty-six women who had a strong family history of breast cancer (BC) who had either undergone (n=26) or were considering (n=20) BPM. Participants were recruited from Australia and New Zealand (NZ) via hospitals, a genetics clinic, a research cohort, a registry and online. RESULTS Four themes underpinning the influences on decision-making were identified: fear and anxiety, children, personal experiences with BC, health professionals influence. CONCLUSIONS The decision to undergo BPM for younger women (<35) was multifaceted, however, it appeared that fear and anxiety were the main influence. Younger women appear more anxious than previous research with older women. There appears to be few differences between those with confirmed BRCA1/2 mutations and those with no known mutation and this is clinically significant. PRACTICE IMPLICATIONS These findings have important practice implications, particularly improving communication of risk statistics, especially to those with no known mutation. Health professionals need to take into account the way younger women perceive information given to them when discussing risk.

Perceived influence of psychological consultation on psychological well-being, body image, and intimacy following bilateral prophylactic mastectomy: A qualitative analysis

This study explored whether psychological consultation offered to women prior to bilateral prophylactic mastectomy (BPM) appeared to provide psychosocial benefit to younger women (<35 years) at high risk of developing breast cancer due to a mutation or family history.