BREAST CANCER AND WOMAN’S REPRODUCTIVE FUNCTION (LITERATURE REVIEW)

Breast cancer (BC) heads a list of diseases of women in Russia, almost one fourth of all patients are in reproductive age. In 2009 BC was diagnosed in 23 % of all women younger than 45 y. o., who were diagnosed the malignant neoplasm for the first time. Polychemotherapy has a gonadotoxic effect, when the disturbance of ovarian function may vary from transient amenorrhea to development of premature menopause. The article considers the condition of reproductive function in women with BC: possibility of pregnancy during and after chemotherapy at the background of hormonotherapy and intervals safe for pregnancy. It sets out the results of research of pregnancy and birth in the BC patients. Operative treatment of phase I and phase II of BC may be carried out during any trimester of pregnancy. Modified radical mastectomy is more preferable. It is advisable to refrain from organ-preserving surgical interventions as the radiotherapy of pregnant women shall be suspended till the end of pregnancy. In case of relevant indications, the polychemotherapy may be carried out beginning from trimester II of the pregnancy. The last course of chemotherapy shall be completed at least 4 weeks before the delivery. The chemotherapy is contraindicative during trimester I of the pregnancy, as the teratogenic effect of antineoplastic drugs is very high especially during this period. Hormonotherapy is not recommended today for BC treatment in pregnant women. Tamoxifen exerts strong teratogenic effect and in 20 % of cases leads to impaired development of facial bones and genitourinary system. The article sets out the results of observations children of patients treated by chemotherapy during the pregnancy. Using of assisted reproduction helps to preserve the genetic material in BC patients. Multifollicular ovarian stimulation in patients with hormone-dependent breast cancer, which may entail the potential risk of recurrence, is still quite controversial matter.

1. Давыдов М.И., Аксель Е.М. Статистика злокачественных новообразований в России и странах СНГ в 2009 г. Вестник РОНЦ им. Н.Н. Блохина РАМН 2010;22(3):172. [Davydov M.I., Aksel E.M. Statistics of malignant neoplasms in Russia and CIS countries in 2009. Vestnik RONC im. N.N. Blokhina RAMN = Bulletin of N.N. Blokhin Russian Cancer Research Center of RAMS 2010;22(3):172. (In Russ.)].

2. Partridge A.Н., Gelber S., Peppercorn J. et al. Web-based survey of fertility issues in young women with breast cancer. J Clin Oncol 2004;22(20):4174–83.

3. Oktay K., Sönmezer M., Oktem O. et al. Absence of conclusive evidence for the safety and efficacy of gonadotropin-releasing hormone analogue treatment in protecting against chemotherapy-induced gonadal injury. Oncologist 2007;12(9):1055–66.

4. Walshe J.М., Denduluri N., Swain S.М. Amenorrhea in premenopausal women after adjuvant chemotherapy for breast cancer. J Clin Oncol 2006;24(36):5769–79.

5. Reh A., Oktem O., Oktay K. Impact of breast cancer chemotherapy on ovarian reserve: a prospective observational analysis by menstrual history and ovarian reserve markers. Fertil Steril 2008;90(5):1635–9.

6. Azim A.А., Costantini-Ferrando M., Oktay K. Safety of fertility preservation by ovarian stimulation with letrozole and gonadotropins in patients with breast cancer: a prospective controlled study. J Clin Oncol 2008;26(16):2630–5.

7. Smith L.N., Dalrymple J.L., Leiserowitz G.S. et al. Obstetrical deliveries associated with maternal malignancy in California, 1992 through. Am J Obstet Gynecol 1997; 184(7):1504–12.

8. Пароконная А.А., Нечушкин М.И., Кампова-Полевая Е.Б. Рак молочной железы и беременность: диагностика, лечение, прогноз. Маммология 2005;1:33–6. [Parokonnaya А.А., Nechushkin M.I., Kampova-Polevaya E.B. Breast cancer and pregnancy: diagnostics, treatment, prognosis. Mammologiya = Mammology 2005;1:33–6. (In Russ.)].

9. Anderson B.О., Petrek J.А., Byrd D.R. et al. Pregnancy influences breast cancer stage at diagnosis in women 30 years of age or younger. Ann Surg Oncol 1996;3(2):204–11.

10. Noyes R.D., Spanos W.J. Jr., Montague E.D. Breast cancer in women aged 30 and under. Cancer 1982;49(6):1302–7.

11. Пароконная А.А. Рак молочной железы и беременность (особенности клиники, диагностики и лечения, прогноз). Дис. … д-ра мед. наук. М., 2009. [Parokonnaya А.А. Breast cancer and pregnancy (peculiarities of clinical image, diagnostics and treatment, prognosis). Thesis of … Dr. scient. med. Moscow, 2009. (In Russ.)].

12. Mueller B.А., Simon M.S., Deapen D. еt al. Childbearing and survival after breast carcinoma in young women. Cancer 2003;98(6):1131–40.

13. Щепотин И.Б., Зотов А.С., Лебедева О.И. Рак грудной железы и репродуктивная функция женщины: рак грудной железы у беременных и вопросы сохранения фертильности после лечения. Клиническая он- кология 2012;5:59–63. [Schepotin I.B., Zotov A.S., Lebedeva O.I. Breast cancer and woman’s reproductive function: mamma cancer in pregnant women and considerations of fertility preservation after treatment. Klinicheskaya onkologiya = Clinical Oncology 2012;5:59–63. (In Russ.)].

14. Чайка В.К., Гюльмамедова И.Д., Ласочко С.А. и др. Рак молочной железы и беременность. Обзор литературы. Мам- мология 2009;1:289. [Chayka V.K., Gyulmamedova I.D., Lasochko S.A. et al. Breast cancer and pregnancy. Literature review. Mammologiya = Mammology 2009;1:289. (In Russ.)].

15. Hahn K.М., Johnson P.Н., Gordon N. et al. Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero. Cancer 2006;107(6):1219–26.

16. Aviles A., Neri N. Hematological malignancies and pregnancy: a final report of 84 children who received chemotherapy in utero. Clin Lymphoma 2001;2(3): 173–7.

17. Bartelmes L., Gateley C.А. Tamoxifen and pregnancy. Breast 2004;13(6):446–51.

18. Tiboni G.M. Aromatase inhibitors and teratogenesis. Fertil Steril 2004;81(4):1158–9.

19. Ives A., Saunders C., Bulsara M., Semmens J. Pregnancy after breast cancer: population based study. BMJ 2007; 334(7586):194.

20. Шарипова Н.Ю. Возможности сохранения репродуктивной функции у женщин, больных раком молочной железы. Дис. … канд. мед. наук. М., 2012. [Sharipova N.Yu. Possibilities of reproductive function preservation in women with breast cancer. Thesis … of Ph.D. in Medecine. Мoscow, 2012. (In Russ.)].