How much does risk go up if having kids after 35 with FH? :(

magda12 · July 2015

After many years of waiting for the right guy, he's finally come along and I've been excited to think I might become a mommy after all.

However, at 36, I am having a BC scare (lump on left breast, invisible in both mammo and u/s, felt by doc) and even if I come out clean from this awful experience, I read that not having kids after 35 tremendously raises your risk to develop it. Big time.

I have FH (paternal grandma died from in her early 40's, dad had colon cancer now in remission), dense breasts and for many years, I drank a lot of alcohol. And, as mentioned, I don't have kids.

Is it smarter/less selfish to forget the dream? Is there any way I could super protect myself if I do decide to procreate? Crap, I wish I had looked into this a decade ago.

Thanks for any advice.

inks · July 2015

I had a baby at 24 and 35, breastfed both and still got cancer. Go figure.

vlnrph · July 2015

For breast cancer, I'm aware that NEVER having children/full term pregnancy is what raises risk, a trend noted in nuns for instance. Delivery prior to age 30, and nursing, on the other hand, is protective. I don't think I've heard anything about the mid-thirties being a pivotal point except in terms of declining fertility and increase in birth defects, along with multiples like twins. I guess the conclusion would be to use female parts for their intended purpose while young! Do you have a reference source for your information?

In terms of your case, the hormone status of any possible tumor is important. Lobular lesions, which are difficult to detect on scans due to their growth pattern, are mostly estrogen & progesterone receptor positive. The more common ductal lumps are easier to see and feel. If you have a biopsy, be sure to get a copy of the pathology report. Meanwhile, try not to worry too much about what might have been.

A referral to a certified genetic counselor might be a good idea, to sort out the significance of your family history.

lintrollerderby · July 2015

As for pregnancy/breastfeeding having a mitigating effect on breast cancer risk and/or development--that's unclear. Most studies that produced results that favored the risk-reduction hypothesis, were exclusive to the more common ER+/PR+/HER2- low grade breast cancers or Luminal A (the kind typically, though not always, seen in post-menopausal women). Most studies with data that points toward the protective benefits are retrospective, meaning the researchers combed the available data. While I want to stress that this is perfectly acceptable and a very common method for data aggregation, the downside is, the conclusions are largely based on available data and doesn't include other mitigating factors, both those which are known and those that are unknown. For instance, researchers may unknowingly select a cohort of patients that geographically includes mitigating factors such as: genetic population, absence or presence of toxins, and climate (possible Vitamin D association). All of those and more could potentially affect the data and lead to assumptions of causation rather than correlation.

The more aggressive breast cancers that tend to develop in pre-menopausal women such as Triple Negative, for example, which is often the subtype linked with a pregnancy-associated breast cancer diagnosis, has so far been shown in studies to not experience the same tentative risk reduction from pregnancy and/or breastfeeding. There exists a small number of studies in which a possible reduction correlation was found, but many researchers favor the older and more robust data on this subtype of breast cancer and its association with pregnancy. In fact, the results of one study tended to show a reduction in risk for Luminal A (ER+/PR+/HER2- and low grade) with increased pregnancies and breastfeeding and a younger age at first pregnancy; however, the same study showed the opposite effect for TNBC risk. The study team actually noticed an increase in risk for that group with each pregnancy and for earlier first pregnancy. So, it's safe to say that the effects of pregnancy and/or breastfeeding on breast cancer risk are not well understood enough to give clear and consistent answers about the role, if any, it plays.

What I'm getting at is there are no hard and fast rules about definitive risk-reduction strategies. For every hypothesis offered, there are groups of patients--whose very existence as patients--show that the answer is not so simple. Just in these forums alone, there are plenty of women who possessed virtually no other risk factors besides being women and aging, and yet still developed breast cancer.

Perhaps you should speak to a genetic counselor so that any risk factors you have can be elucidated and analyzed so that you can get a much more quantifiable determination of your overall level of risk. I hope that your current worry turns out to be benign.

vlnrph · July 2015

Excellent summary from lintrollerderby (what a great screen name!) The history showing her personal background regarding these diagnoses gives extra weight to the analysis.

My approach was somewhat simplistic because there are so many confounding factors. The only baby I had, at age 30, was 8 weeks premature. Nursing was not successful. Twenty years later, I had two tumors, of different pathology. It is impossible to predict the future but we do need to understand the potential risks, living as well as we can in the meantime...

The bottom line would be: become as well informed as possible, make your decision and then move forward.

magda12 · July 2015

Ladies, thank you so much for your excellent, informed responses.

I joined a forum of colon cancer patients when my dad was diagnosed and I was impressed by how much more informed and helpful the patients were than many doctors. Truly grateful for them, and for you as well.

This is the article I read: http://ww5.komen.org/BreastCancer/NotHavingChildrenorHavingFirstAfterAge35.html

While I was very preoccupied about having a baby a few years back, my thinking now is that perhaps there's a reason I didn't get the chance. If it happens, it happens and I will do what's in my power to take care of myself.

Again, thank you all.

lintrollerderby · July 2015

vlnrph: Thanks so much for the kind words! I wholeheartedly agree with how you stated the bottom line: "The bottom line would be: become as well informed as possible, make your decision and then move forward." That's the best advice to someone in the position in which magda12 finds herself.

magda12: You're welcome and I'm glad that vlnrph, inks, and I could help you some with this situation. I understand your worry. I really do think that an appointment with a genetic counselor would be best. Unfortunately, there's probably no way to learn what the pathology was from your paternal grandmother's breast cancer. I know HER2 wasn't routinely tested until about 10 years ago, and I think ER and PR weren't tested until the 1980s. Knowing what her hormone receptor and HER2 status was could possibly aid in identifying whether she had familial or sporadic breast cancer, and thus, whether your father's colon cancer was coincidence or possibly linked. The reason being that most--though not all as there are no absolutes in cancer--breast cancer that is HER2+ is unlikely to be hereditary. There are exceptions of course. It can be particularly tricky when looking at male-dominated lines or small families. That's how my own BRCA1 mutation was able to hide itself.

Best of luck to you.

How much does risk go up if having kids after 35 with FH? :(

Comments

Categories