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Breast Cancer and Fertility: Know Your Options By Stephanie Sciara-Glaser Vice President Long Island 2 Day Walk To Fight Breast Cancer, Inc. When a woman is diagnosed with breast cancer, she faces many difficult questions. The diagnosis and efforts to find the best doctors and the best treatments can be overwhelming. She may be unsure about what the cancer will mean to her future. What if she was thinking of having a baby before she was diagnosed? What options exist that will allow a woman to receive the most effective treatment for her cancer while preserving her fertility? More than 11,000 women under the age of forty are diagnosed with breast cancer in the U.S. each year and face this dilemma. When oncologists determine a course of treatment for breast cancer patients, consideration is first given to life saving measures followed by quality of life concerns. With the growing number of cancer survivors in the United States, greater attention is being given to quality of life concerns. Until recently, fertility preservation was rarely a consideration in treating breast cancer patients. Because oncologists are trained to provide the best cancer treatment available -- not necessarily in light of fertility options -- patients interested in seeking information on fertility need to be proactive. "A patient needs to say to herself, 'What do I want in the future' and ask the doctor, 'What's this treatment going to do with my future plans for fertility?'" says Ann Partridge, MD, MPH, breast oncologist and instructor at Harvard School of Medicine in Boston. She suggests getting a third or even fourth opinion, ideally from doctors in different specialties -- oncology, reproductive endocrinology, gynecology -- since each will provide a unique perspective. How breast cancer affects fertility will depend mostly on three variables: the type of treatment required, the stage of the diagnosis, and the patient’s age. If a patient needs only surgery and radiation without chemotherapy, the treatment should have no impact on future fertility. The more advanced the cancer upon detection, the greater likelihood that chemotherapy, which affects the whole body, will be used to treat it. Breast cancer patients treated with chemotherapy are very likely to develop premature ovarian failure or early menopause. Chemotherapy works by utilizing various drugs to destroy the cancer cells and hinders the division of the cells. While it is an effective form of treatment, it is also the treatment most likely to damage fertility. Because estrogen plays a role in the development of breast cancer, part of the chemotherapy’s role in treatment is to interfere with the production of estrogen. As a result, almost four out of five women treated with cyclophosphamide will develop ovarian failure, according to Kutluk Oktay, MD, assistant professor at Cornell's Center for Reproductive Medicine and Infertility. If you're 30, your fertility is already declining. With chemotherapy, you add on a few more biological years and chemotherapy has been known to cause the early onset of menopause.
Other methods of fertility preservation are experimental but show promise. Egg freezing, which applies the same concept as embryo freezing, has proven less effective -- most likely because eggs are smaller, and less hardy, than embryos. There's also ovarian suppression during treatment (GnRH AnalogTtreatment) which protects ovaries to some degree from the chemical assault precipitated by chemotherapy by administering hormones to suppress ovarian activity and create temporary menopause. Freezing entire strips of ovarian tissue is a third technique under investigation; it involves surgically removing, storing, and later replacing the tissue in another part of the body. At this time, seven live births have been published in peer-reviewed journals using various methods of transplanted ovarian tissue.
Hopefully, this initiative and others like it will serve as a model for the development of an interdisciplinary approach to fertility issues throughout the country that will usher in a new era in the treatment of women with breast cancer. For additional information and resources please visit: http://oncofertility.northwestern.edu |
Fertility preservation options are specific to an individual patient, and will depend on how long she is able to safely delay the start of treatment, her age, and whether she has a partner or access to donor sperm. Freezing embryos (fertilized eggs) created by in vitro fertilization (IVF) is the most widely used and effective method, but there are potential downsides. IVF takes three to four weeks, a delay in cancer treatment that, depending on the stage and type of cancer, patients may or may not be able to afford. Sperm -- either from a partner or donor -- must be made available immediately to fertilize the eggs. And IVF is expensive -- anywhere from $10,000 to $14,000 per cycle. However, the success rate is as high as 40%.