Young Women Face Fertility Challenges

During the next 10 years, one in every 250 women between 30 and 40 will be diagnosed with breast cancer. Not only are they battling an insidious disease, they are grappling with its impact upon fertility, sexuality and their overall health. Simply becoming pregnant after a diagnosis of breast cancer does not appear to increase the risk of breast cancer recurrence, said Dr. Andrew Seidman, associate attending physician, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center.¹ However, because recurrences tend to appear earlier rather than later, oncologists now generally advise waiting a minimum of two years, preferably five years, following treatment to become pregnant. Since estrogen circulates at higher levels during pregnancy, waiting at least two years is particularly important for women with ER+ breast cancer, he advised.

Also, becoming pregnant may not be easy. Many chemotherapeutic drugs can lower fertility, Dr. Seidman noted. Studies are now examining the possible benefit of suppressing the function of the ovaries with medications while a woman is undergoing chemotherapy. Some evidence suggests that protecting the ovaries this way may facilitate fertility later on, he explained. Another possibility, albeit a delicate one, is harvesting eggs or embryos before undergoing chemotherapy. Stimulating the ovaries to produce eggs or freezing fertilized embryos is possible between diagnosis and chemotherapy. The potential risks are significant for women with ER+ breast cancer because the hormones used to stimulate the ovaries may also stimulate cancer cells. Despite this, Dr. Seidman noted, specialists who know how to balance hormones in breast cancer patients can supervise egg harvesting successfully. While oncologists try their best to optimize treatment and minimize its side effects, some chemotherapy regimens induce early menopause. As a result, great concern is accelerated bone loss, which occurs when the sudden loss of estrogen causes bones to leach calcium, rendering bones more brittle. Several clinical trials, Dr. Seidman pointed out, are now focused on bone-protecting drugs, known as bisphosphonates, to alleviate and slow down osteoporosis in these women.

Other important studies question the addition of an ovarian suppressing drug to tamoxifen, or adding an aromatase inhibitor to an ovarian suppressing drug to prevent recurrence in premenopausal patients with early stage breast cancer. These trials are particularly relevant for young women who continue to menstruate after breast cancer treatment, but they are also critical because premenopausal women tend to have aggressive cancer.“Clearly, there is a sense that young women have biologically more aggressive disease, but we don’t know exactly why,” continued Dr. Seidman. There is a paradox, however, in that some fast-growing cancers are sometimes more sensitive to chemotherapy, he added, so this does not necessarily imply a worse prognosis.

While the results of the above trials will not be known for several years, researchers are constantly gaining new information from clinical trials reaching their completion today. For this reason, patients should always ask their doctors what the latest research shows regarding the treatment the doctor is recommending: how effective is this protocol and does it affect young women differently? What are the long-term side effects? What are my chances of 40-or 50-year survival? Are there clinical trials underway right now that may benefit me if I participate? Patients may also ask their doctors: how many young women have you treated for breast cancer? How familiar are you with ongoing research aimed at young women? It may also be important to address the fact that follow-up care in young breast cancer patients differs from that in the
general patient population. What are the chances that the suggested treatment will induce menopause and will this menopause be temporary or permanent? How will adjuvant treatment impact future fertility? Young women with no family history are less likely to practice breast self-exam (BSE) or have a clinical exam.

A woman must be her own advocate; she must listen to her gut, go back to her doctor, get that second opinion, and ask many questions.

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¹Souce: American Cancer Society

Resource

Fertile Hope
www.fertilehope.org
(800) 994-HOPE

Founded in October 2001, Fertile Hope is a national nonprofit organization dedicated to providing reproductive information, support and hope to cancer patients whose medical treatments present the risk of infertility.