Fertility and Pregnancy Counseling of Breast Cancer Patients with Germline BRCA Mutations.

Irrespective of their family history, approximately 12% of breast cancer cases diagnosed in women under the age of 40 are hereditary tumors secondary to the presence of germline deleterious mutations in the breast cancer susceptibility genes BRCA1 or BRCA2. The indication to undergo risk-reducing salpingo-oophorectomy at a young age for women carrying a mutation in the BRCA genes has a direct negative impact on patients’ fertility and family planning. In addition, preclinical and limited clinical evidence suggests a possible negative effect of a BRCA mutation on female ovarian reserve and fertility. Based on both the unique features and needs of these patients as well as the limited evidence on the performance of fertility preservation strategies and on the safety of having a pregnancy following the end of anticancer treatments, oncofertility counseling is particularly complex in young women with newly diagnosed BRCA-mutated breast cancer. This chapter aims to review the available evidence on the impact of carrying a germline deleterious BRCA mutation on the reproductive potential of these women as well as to discuss how to optimally manage the oncofertility counseling of young BRCA-mutated breast cancer patients facing fertility and pregnancy-related issues.info:eu-repo/semantics/publishe

Breast Cancer

Breast cancer is the most common cancer in young women. Fortunately, the survival rates are very high, especially in the early stages. Chemotherapy can lead to amenorrhea and infertility, especially in women >30 years of age. The most common chemotherapies impose a significant risk of premature ovarian insufficiency, especially in women >30 years of age. In these women GnRH agonists, freezing of oocytes and freezing of ovarian tissue alone or in combination are options to preserve fertility. If ovarian stimulation is chosen, aromatase inhibitors should be added in estrogen-sensitive cancer to reduce estrogen blood concentrations