Low Resumption Rates of Breast Cancer Treatment Among Women Post-Pregnancy

Recent research highlights a concerning trend among women diagnosed with hormone receptor-positive breast cancer, particularly those who pause their treatment during pregnancy. While these patients are often advised to resume endocrine therapy after childbirth to mitigate the risk of cancer recurrence, a significant number fail to do so.

Endocrine therapy, which is critical for managing breast cancers that thrive on estrogen, typically involves medications that must be discontinued during pregnancy and breastfeeding. The ideal scenario is for women to recommence this treatment promptly after delivery. Previous clinical trials suggested that around 75% of premenopausal women who paused their therapy to conceive resumed treatment, with a low recurrence rate of about 9% in the years following childbirth.

However, a new study led by Stanford Medicine researchers reveals starkly different findings. In their retrospective analysis, it was discovered that only approximately one-third of women who paused endocrine therapy due to pregnancy actually resumed it after giving birth. Moreover, only two-thirds of these women returned to regular breast imaging to monitor for potential recurrence. Alarmingly, nearly 20% of participants experienced a recurrence of their breast cancer within a decade after their initial diagnosis.

These findings suggest a significant gap in treatment adherence, which could be contributing to poorer health outcomes for this demographic. Julia Ransohoff, a clinical fellow in hematology and oncology, emphasizes the need to understand the barriers that prevent women from resuming treatment. With rising breast cancer rates among younger women, addressing this issue is becoming increasingly vital.

The study, published in JAMA Oncology, analyzed data from 215 women diagnosed with breast cancer between January 2000 and October 2024 who later became pregnant. The participants had a median age of 33.6 years at the time of diagnosis. Out of these women, 75% were eligible for hormone therapy, yet only 32% completed five years or more of treatment. Among the 81 who paused their therapy during pregnancy, only 36 resumed it.

The researchers highlighted various reasons that might contribute to the reluctance in continuing treatment. The medications involved in endocrine therapy can cause significant side effects, including menopausal symptoms, mood disturbances, and joint pain, which can be exacerbated by the stress of new parenthood.

Among the women eligible for breast imaging following delivery, 67% resumed their screenings. This indicates a broader trend where patients may perceive that the completion of chemotherapy signifies the end of their treatment journey, not realizing that ongoing therapy and monitoring are equally crucial.

The research team advocates for further studies to explore the underlying reasons for low adherence to treatment guidelines among breast cancer patients across various backgrounds and regions. They aim to develop a prospective study integrating patient feedback on their treatment experiences and challenges.

Understanding the perspectives of these patients is essential for improving adherence rates, especially considering that even older women exhibit low compliance with five years of endocrine therapy. The complexities of balancing cancer treatment with the demands of family life require a tailored approach to care.

As awareness grows about the challenges faced by younger breast cancer survivors, healthcare providers are encouraged to engage in meaningful discussions with patients to facilitate better treatment adherence. Addressing these issues proactively can lead to improved health outcomes and quality of life for women navigating the dual challenges of breast cancer and motherhood.