Breast cancer in under 40s, pregnancy after treatment is possible: here's the latest from science

Oncofertility. If until a few decades ago it might have seemed a dream just to mention this term, that is no longer the case. Think of breast cancer, for which it is increasingly important to respect the desire to become pregnant after the disease and cancer treatments. Science is progressing, and fast, on this front. And not only because women are becoming increasingly attentive to the opportunity to preserve their eggs (today one in four decides to 'put aside' egg cells before the start of chemotherapy cycles), but also because the opportunities to better manage this condition on the hormonal stimulation front are improving. It is now known that this does not adversely affect the prognosis of the tumour, as it does not increase the risk of recurrence. This is stated by the results of the PREFER study, coordinated by the University of Genoa - San Martino Hospital in Genoa, which involved 746 women (aged between 18-45 years) and was recently presented at the international San Antonio Breast Cancer Symposium.

The topic of female fertility preservation is also at the centre of the national Back From San Antonio conference being held in Genoa "It should not be considered as a disease that only affects women in menopause or over 65," emphasises Lucia Del Mastro, Full Professor and Director of the Medical Oncology Clinic at the IRCCS Ospedale Policlinico San Martino, University of Genoa. In Italy, about one in ten cases affects women under 40, while it accounts for more than 40% of all cancers diagnosed before the age of 50. They are usually aggressive neoplasms whose management is complex not only from a clinical but also from a psychological point of view, precisely because of the different needs of a young woman. These include the need to get pregnant after the disease and anti-tumour treatments'. Why is it important to offer this opportunity? When it affects a young woman, under the age of 40, the tumour is often biologically more aggressive. Moreover, the risk that it is a hereditary neoplasm, linked to the presence of pathogenic BRCA mutations, is higher than in cases diagnosed at an older age. There are also aspects that certainly should not be underestimated when talking about young women. In addition to guaranteeing the excellent cure probabilities currently achieved, it is necessary that the course of treatment provides for equal prospects and expectations with healthy peers. For a young woman to become a mother. For years, the Genoa team has been studying the side effects of cancer therapies that can lead to ovarian dysfunction, premature menopause and infertility. Thanks to appropriate and personalised treatments, also developed through studies conducted by our research group at San Martino-University of Genoa, it is increasingly possible to become a mother even after cancer.

The time factor is crucial. It is necessary that, as is the case in the most advanced centres, the woman's access to the fertility preservation pathway be almost simultaneous with the oncologist's visit. "Over the years we have identified strategies capable of combining the inevitable needs of treatment with the patient's wishes for motherhood," reports Matteo Lambertini, Coordinator of the PREFER study and Associate Professor of Medical Oncology at the University of Genoa-IRCCS Ospedale Policlinico San Martino. For a long time we oncologists, for fear of a possible recurrence, considered hormonal stimulation as potentially dangerous. With the new study, however, it has been shown that there are no negative effects of the treatment. To freeze oocytes, hormonal stimulation is required for a limited period of time, usually only 10-15 days. The results of the PREFER study may provide new perspectives to improve onco-fertility counselling in premenopausal women with early-stage breast cancer'.

The Genoa conference also provided food for thought on the role of lifestyle habits in prevention, and the importance of combating the smoking habit in cancer prevention was recalled. A collection of signatures for a popular initiative law will start soon. "We are proposing to Parliament to increase the cost of all tobacco products by 5 euros," emphasises Francesco Perrone, President of the AIOM Foundation. We are convinced that only a sharp increase in the price of cigarettes can be effective in combating one of the most dangerous cancer risk factors. As reiterated at the annual meeting in Genoa, Italy is at the forefront of scientific cancer research in Europe and the world. However, primary prevention remains an indispensable weapon for reducing the impact of cancer on our society and the National Health Service. Smoking still contributes to too many cancers that often have high mortality rates. So we ask the public to help us and support our bill'