Majority of young women treated for breast cancer can go on to have children

New research has found that young women who have survived breast cancer can go on to have children. The study, which tracked nearly 200 young women treated for breast cancer, found that most of those who tried to conceive during a median of 11 years after treatment were able to become pregnant and give birth.

The findings were presented at the 2024 Annual Meeting of the American Society of Clinical Oncology (ASCO), which was held recently in Chicago.

The patients in this study were participants in the Young Women’s Breast Cancer Study, which is tracking the health of a group of women diagnosed with breast cancer at or under the age of 40. Of 1,213 eligible participants, 197 reported an attempt of pregnancy over a median follow-up period of 11 years. Within this latter group, the median age at the time of diagnosis was 32 years, and most were diagnosed with hormone receptor-positive breast cancer. Participants were periodically surveyed about whether they had tried to become pregnant and whether they had conceived and given birth.

Over the course of the study, 73% of women attempting to conceive achieved a pregnancy and 65% had a live birth, researchers found. Those who opted for fertility preservation by egg/embryo freezing before cancer treatment tended to have a higher live birth rate, while older participants tended to have lower pregnancy and live birth rates.

Participants in the study had breast cancers ranging from stage 0, which are non-invasive and confined to the inside of the milk duct, to stage III, in which the cancer has spread to the lymph nodes. Researchers found that the stage of the disease at diagnosis wasn’t statistically associated with achieving a pregnancy or live birth.

“For many young women with breast cancer, the ability to have children following treatment is a major concern. The findings of our study can be helpful when counselling patients about fertility issues. The finding that egg/embryo freezing before treatment was associated with a higher live birth rate underscores the need for accessibility to fertility preservation services for this population,” said the study’s first author, Kimia Sorouri of the Dana-Farber Cancer Institute in Boston.

Ultra-sensitive blood test can predict recurrence of breast cancer before relapse

New research has found that a novel blood test can predict the recurrence of breast cancer in high-risk patients, months or even years before they relapse.

A team from the Institute of Cancer Research (ICR) in London, used an ultra-sensitive liquid biopsy to detect the presence of tiny amounts of cancer DNA left in the body following treatment for early breast cancer. 

Presented at ASCO, the findings involved analysing blood samples from the ChemoNEAR sample collection study for circulating tumour DNA (ctDNA) that is released into the bloodstream by cancer cells.

“Breast cancer cells can remain in the body after surgery and other treatments, but there can be so few of these cells that they are undetectable on follow-up scans. These cells can cause [patients with] breast cancer to relapse many years after their initial treatment. Ultra-sensitive blood tests could offer a better approach for the long-term monitoring of patients whose cancer is at high risk of returning,” explained lead study author Isaac Garcia-Murillas, a staff scientist at the ICR.

By helping to spot the patients most likely to relapse, the researchers hope the results will lead to a new strategy for recurrent breast cancer treatment, which  can be started much earlier, without waiting for incurable, advanced disease to show up on a scan.

Although earlier studies have shown that ctDNA blood tests can identify relapse before it can be seen on a scan, most tests use a technique called whole exome sequencing (WES) as it focuses on the exons – the protein-coding regions of genes – which are directly related to diseases. However, the approach in this study involves sequencing the entire genome, known as whole genome sequencing (WGS). This enabled researchers to identify up to 1,800 mutations, which is much more sensitive and includes a larger number of cancer-related changes that could occur in a patient’s DNA.

For this study, researchers used blood samples from the ChemoNEAR sample collection study to detect the presence of ctDNA in 78 patients with early breast cancer – 35 of whom had HER2-positive breast cancer, 23 had triple-negative breast cancer, 18 had hormone receptor-positive breast cancer and two had an unknown breast cancer subtype. 

The samples were collected from the women at diagnosis before their therapy, after the second cycle of chemotherapy, following their surgery and every three months during follow-up for the first year. After that, samples were collected every six months for the next five years.

The results showed that detection of ctDNA at any point after surgery or during the follow up period was associated with a high risk of future relapse and poorer overall survival.

This proof-of-principle retrospective study lays the groundwork for better post-treatment monitoring and potentially life-extending treatment in patients.

“Testing a patient’s blood for ctDNA will allow clinicians to diagnose the return of cancer at the very earliest stage. However, further research and testing are needed before we can demonstrate whether detecting molecular residual disease could guide therapy in the future,” said study co-author Nicholas Turner, professor of molecular oncology, ICR and a consultant medical oncologist at the Royal Marsden National Health Service Foundation Trust in the UK.