Exploring the Empirical and Experiential Landscape of the Perinatal Period After Breast Cancer

Abstract

Background: Young women with breast cancer (YWBC) cite family building as a top concern at diagnosis. While pre-treatment fertility and reproductive concerns have been well researched, little is known about the experiences of young women with a history of breast cancer (YWHBC) in the perinatal period. Additionally, YWHBC report increased distress due to the lack of information available to help navigate pregnancy and postpartum. Thus, this dissertation sought to better understand the empirical and experiential landscape of the perinatal period for YWHBC. Methods: Study 1 entailed a scoping review of the empirical landscape regarding perinatal outcomes after breast cancer (BC). Importantly, considerations such as the impact of genetic mutations (BRCA 1 and 2), disease characteristics common for younger populations (e.g., HR+), the impact of assisted reproductive technology (ART), and breastfeeding and screening options for YWHBC were included. Study 2 consisted of a thematic analysis exploring participant perspectives regarding extant knowledge, questions, and concerns that arise for YWHBC in the perinatal period. Results: Study 1 findings suggest that, generally, becoming pregnant after BC does not impact overall survival for YWHBC, including for women with BRCA mutations, HR+ disease, and those who use ART to become pregnant. Further, breastfeeding may be possible after BC treatment, and various screening options are possible for women who are actively breastfeeding. Study 2 revealed a number of themes related to the experiences of the perinatal period and supportive care after BC. All participants identified that increasing access to trusted, empirical information, along with tailored support resources may help to ease the psychological burden for YWHBC in the perinatal period. Conclusions: Together, these two studies highlight the many nuanced considerations for YWHBC during the perinatal period. Study 1 helped to illuminate the empirical landscape regarding the safety of the perinatal period for YWHBC. Study 2 identified themes relating to the complex nature of having children after BC, for patients and others involved in their care, illuminating gaps in knowledge and supportive care. Ultimately, both studies will be used to inform the development of an online education tool to improve quality of care for this unique population.