Patient discussions
Following treatment of breast cancer, the clinician is often asked about the safety of future pregnancies. One meta-analysis showed that child-bearing after treatment for invasive breast cancer does not increase the risk of recurrence or death from breast cancer.[490]
The risks and benefits of pregnancy in this setting should be discussed with each patient. Women should wait at least 2 years before attempting to become pregnant. Women should wait 3 months after stopping tamoxifen, and at least 7 months following completion of trastuzumab, before attempting to conceive. The POSITIVE trial will assess the safety of adjuvant endocrine therapy interruption while attempting to conceive.[491]
Birth control
Hormonal birth control use is discouraged after treatment for primary invasive breast cancer. National Comprehensive Cancer Network (NCCN) guidelines recommend that women should be counselled about alternative birth control methods such as intrauterine devices, barrier methods, tubal ligation, and vasectomy. Breastfeeding is not recommended during endocrine therapy or chemotherapy.[124] Breastfeeding can be considered after breast-conserving therapy, although irradiation may reduce or prevent lactation.
Recurrence
Patients may enquire about the risk of developing another breast cancer.
In women diagnosed with early invasive breast cancer, the annual incidence rate of isolated breast tumour recurrence is 0.6%, and of contralateral breast cancer is 0.5%.[492] A meta-analysis of risk factors for metachronous, contralateral breast cancer identified BRCA1 or CHEK2 mutation, family history of primary breast cancer, lobular primary breast cancer, oestrogen receptor-negative primary breast cancer, body mass index (BMI) ≥30 kg/m², and treatment with radiotherapy before age 40 as being associated with an increased risk of contralateral breast cancer. Older age at diagnosis of primary breast cancer, treatment with chemotherapy, and treatment with hormone therapy are all associated with decreased risk of metachronous contralateral breast cancer.[493]
Physical activity and diet
The American Society of Clinical Oncology recommends regular aerobic and resistance exercise during active treatment with curative intent.[494]
Physical activity should be encouraged as soon as possible after diagnosis, with guidance provided in order to help patients prepare for treatments, tolerate and respond to treatments, and manage some cancer-related symptoms and treatment-related adverse effects.[495] One meta-analysis showed that physical activity is associated with weight reduction, lower BMI, lower body fat percentage, and increased quality of life in women who have had curative treatment for early breast cancer.[496]
The Women's Health Initiative Dietary Modification trial found that a low-fat (<20% energy) diet with increased fruit, vegetables, and grains was associated with lower risk of breast cancer mortality (hazard ratio 0.79) after a median 19 years' follow-up.[497]
A nutritional assessment and counselling should begin as soon as possible after diagnosis, to prevent or resolve nutrient deficiencies, preserve muscle mass, and manage adverse effects of treatments that may negatively impact nutritional status.[495]
Obesity is associated with poorer overall and breast-cancer survival in pre-menopausal and post-menopausal women.[498]
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