Pregnancy after breast cancer: from psychosocial issues through conception.

Women face numerous issues if they either contemplate childbearing or become pregnant after the diagnosis of breast cancer. Based on a search of the English medical literature from 1966 to 1997, we make the following conclusions regarding pregnancy after breast cancer: (1) Sexual function is not affected by the decision to treat breast cancer by breast conservation vs mastectomy. (2) Infertility after breast cancer treatment is directly proportional to patient age and the use and dose of alkylating agents. There is no conclusive information on the effects of duration, dose intensity, schedule, or route of administration of chemotherapy on subsequent fertility. (3) There appears to be no increase in birth defects in children whose parents were exposed to chemotherapy earlier in life. (4) Milk production of the irradiated breast is likely to be limited. Also, breastfeeding appears to decrease the risk of breast cancer. (5) With respect to monitoring pregnant women for breast cancer recurrence, in general the recommendations made by the American Society of Clinical Oncology (ASCO) regarding monitoring in nonpregnant women should be followed. (6) Pregnancy does not increase the risk of recurrent breast cancer. (7) Adjuvant tamoxifen (Nolvadex) therapy has adverse effects on pregnancy in vivo and in laboratory animals. No reports exist on the effects of tamoxifen on human pregnancy.