Professor Chen Rong: Survival status of young breast cancer patients and choice of fertility timing

In order to better carry out continuing education activities and promote standardized diagnosis and treatment of breast diseases, on September 29, 2022, the 2022 Breast Disease Branch of Beijing Medical Association was held in Beijing, and the second session
of the Breast Disease Branch of Beijing Medical Association was held in this seminar.

During the conference, Yimaitong had the honor to invite Professor Chen Rong from Peking Union Medical College Hospital to share the trend of breast cancer incidence in China and how young breast cancer patients choose the timing
of childbearing.

Expert profiles

Prof.
Rong Chen

• Doctor of Medicine, Chief Physician, Doctoral Supervisor

• Deputy Director of the Center for Gynecology and Endocrinology and Reproduction, Peking Union Medical College Hospital

• Senior researcher at Taihe Think Tank

• Deputy head of the menopause group of the Obstetrics and Gynecology Branch of the Chinese Medical Association

• Vice Chairman of the Reproductive Endocrinology Committee of the Chinese Medical Education Association

• Chairman of Menopause Education and Training Center of China Medical Education Association

• Vice Chairman of the Breast Disease Branch of Beijing Medical Association

• Member of the Standing Committee of the Health Management Professional Committee of the Beijing Society for the Prevention and Treatment of Breast Diseases

• Member of the International Menopausal Society and the European Menopausal Association of Men and Women

• He is the associate editor of Climacteric (Chinese edition), and the editorial board member of 8 journals, including Peking Union Medical College, Chinese Journal of Practical Gynecology and Obstetrics, Reproductive Medicine, and Chinese Journal of Hospital Management

Current situation and trend of breast cancer incidence in China

Prof.
Rong Chen

Peking Union Medical College Hospital

The incidence of breast cancer in Chinese women is generally lower than that of European and American women, but there are relatively more
young breast cancer patients.
At an academic annual meeting in the first half of this year, experts discussed and unanimously agreed to use 40 years as the age cut-off for
young breast cancer.
The median age of breast cancer incidence in European and American countries is 62-64 years old, while the median age of breast cancer incidence in women in China is only 48-50 years old
.
The proportion of young breast cancer patients in China is higher
.
At the same time, compared with older breast cancer, young breast cancer patients have a higher risk of recurrence and death, and a worse
survival prognosis.

Survival status of young breast cancer patients

Prof.
Rong Chen

Peking Union Medical College Hospital

At present, the field of oncology has made particularly great
progress.
Early screening, early diagnosis and treatment, and advances in treatment have greatly improved
the survival of all breast cancer patients, including young breast cancer.
The treatment model of breast cancer in China has become more and more mature, and early breast cancer can even be treated as a chronic disease, with a five-year survival rate of more than
90%.

Timing of fertility in young breast cancer patients

Prof.
Rong Chen

Peking Union Medical College Hospital

For young patients, when the initial goal of "saving life" is achieved, there will be higher demand
.
There are many young breast cancer patients who have not given birth before cancer, or have only given birth to one child, with the liberalization of the national fertility policy, the fertility needs of young breast cancer patients are actually very large
.
We also conducted a small survey and found that many patients have fertility needs that are not adequately valued
.

"Talk about cancer discoloration", many times at the moment of illness, because of the inequality of information, patients will feel that the sky is falling, so when they are just sick, the idea is often that as long as they live, but after treatment, patients find that the efficacy is very good, and can survive
for a long time.
From the perspective of the patient and family, it may be considered whether it is possible to have children
.

The fertility needs of young breast cancer patients can be said to be the product
of medical advances.
But so far, there is some controversy
in this area.
Over the years, a number of registered clinical studies are being conducted around the world and some results
have been achieved.
From the current data, for young breast cancer patients, in the case of proper treatment of the primary disease, fertility will not affect the prognosis
.
Studies have suggested that fertility in breast cancer patients seems to be conducive to survival prognosis, but more rigorously designed studies suggest that "fertility can protect or prolong survival" is not yet conclusive
.
At present, it is relatively certain that fertility has little impact on the prognosis of breast cancer patients
.
For individual patients, it is necessary to fully ensure the safety of the mother, so it
must be considered when breast cancer is relieved.

Treatment of young breast cancer patients requires chemotherapy, radiotherapy, or targeted therapy
.
Of all treatment regimens, chemotherapy is the single factor
that has the greatest impact on a patient's fertility.
Although certain chemotherapy drugs can make breast cancer well relieved, they have a greater
impact on ovarian function.
If the patient also has potential fertility needs, when choosing chemotherapy drugs, try to avoid drugs
such as alkylating agents that may have a serious impact on ovarian function.

The question of when to get pregnant is a common question
.
Firstly, pregnancy is not recommended during chemotherapy; Second, if the patient is on adjuvant endocrine therapy, such as tamoxifen, she cannot become pregnant
during this period.
Tamoxifen, as one of the commonly used drugs in adjuvant endocrine therapy for breast cancer patients, has been shown to have an impact on fertility, mainly reflecting that it may be teratogenic, so it is necessary to stop tamoxifen treatment before getting pregnant
.

In short, for young breast cancer patients, after the primary disease treatment is satisfactory, fertility can be considered, but it must be after chemotherapy is completed, and do not try to get pregnant
during adjuvant endocrine therapy.

Adjuvant endocrine therapy after breast cancer surgery is usually recommended for five years
.
Other studies have found that prolonged adjuvant endocrine therapy may bring more benefits
to patients.
So here's the problem: if you want to treat for five or ten years, the patient is getting older, and waiting until the end of adjuvant endocrine therapy to get pregnant may not be pregnant
.
We recommend that after about two years of treatment, we first stop the drug, then try to get pregnant, and then continue adjuvant endocrine therapy
after childbirth.
However, it should be noted that when adjuvant endocrine therapy is resumed, breastfeeding can no longer be carried out, because tamoxifen has an effect
on the child.

Advice for female friends and breast cancer patients who need to have children

Prof.
Rong Chen

Peking Union Medical College Hospital

For breast cancer patients, there is no clear, universally accepted expert consensus
on when to give birth.
It usually depends on treatment of the primary disease
.
Usually two years after the first diagnosis and treatment of breast cancer, at this time has passed the first postoperative recurrence high incidence period, the condition is relatively stable, and it has been a period of time to stop chemotherapy, you can choose to try to get pregnant
at this time.

Pregnancy preparation also has a lot to do with individual women, and it is not possible to conceive if you want to get pregnant
.
Whether or not a pregnancy can be successfully obtained is also related
to the woman's age and ovarian function.
Usually ovarian function declines
as women age.
The number and quality of oocytes also decrease
.
Therefore, it is recommended that everyone still get pregnant
at a younger age.

For female friends and pregnancy after breast cancer surgery, here are three suggestions: First, we young women, if they have a family, they should have children, do not delay too much, otherwise fertility will decline; Second, the older you are, the body is prone to a variety of problems, we often find such patients clinically: have been working hard, have been almost 40 years old to prepare to have a child, but found breast cancer, so it will be delayed for several years, which is quite troublesome
。 Third, to all young female friends, a reminder: Chinese women have a relatively high proportion of young breast cancer patients, it is recommended that you need to pay attention to starting breast cancer screening at a younger age, or at least do a breast ultrasound before trying to get pregnant, which is especially important
for women over 35 years old who are trying to get pregnant or women with a family history of breast cancer.