Young Women With Breast Cancer Can Face Tough Decisions About Their Future Fertility

Source: ABC News – October 10, 2014

When someone receives a cancer diagnosis, they are usually thinking about how to save their life, rather than what happens after they receive treatment. As a result, many young women diagnosed with breast cancer today are unaware treatments like chemotherapy that can save their life may also impede their future fertility.

Techniques like egg freezing have advanced in recent years, allowing for women with cancer to take advantage of these technologies to preserve their future fertility. But many women are concerned that taking the time to preserve their fertility through egg or embryo freezing might delay their cancer treatment.

Other women may be single and not thinking about planning a family at this stage in their lives, which may cause them to go forward with cancer treatment without knowing the risks to their fertility. Ultimately, primary care physicians, gynecologists, and oncologists should have a conversation about a patient’s future fertility if family building is one of their goals.

Many women are now living long lives cancer-free after treatment for breast cancer and would like to start a family. However, the majority of these women will no longer be able to conceive using their own eggs due to the toxic effects of chemotherapy. Egg or embryo freezing before cancer treatment is often a solution to prevent women from being unable to build their family in the future.

We realize that each person’s situation is unique, and also understand that these patients are facing a life-altering diagnosis, are under tremendous stress, and need to make decisions about their care very quickly. It’s for that reason we created the Oncofertility program at RADfertility.

Our oncofertility program is designed to be a resource for patients with cancer who are interested in preserving their future fertility. In addition, RADfertility is a member of the Oncofertility Consortium, a nationwide initiative spanning multiple medical specialties that strives to reach this goal.

Women who are concerned that pursuing oncofertility may delay cancer treatment have valid concerns; the primary interest of RADfertility is for your overall health and safety. We work closely with your oncologist to make sure that any treatment plan is acceptable. The process of retrieving a woman’s eggs is safe for a woman with breast cancer. Ovarian stimulation and egg retrieval are very similar to a typical IVF cycle. In a majority of cases, we can quickly move to treatment prior to initiation of chemotherapy with almost no delay.

For women who have already undergone treatment and are cancer-free, we can assess their fertility potential and ovarian reserve status to see if there is a chance of spontaneous conception, or if fertility treatments would be an option. The uterus is generally not affected by chemotherapy or breast radiation, and through the use of our frozen donor egg program, many women have gone on to become pregnant and deliver healthy babies.

While most breast cancer appears for women past their reproductive years, a topic that is not often discussed is how some young women inherit their risk of breast cancer. About 5% of breast and ovarian cancers are hereditary, and the overwhelming majority can be attributed to mutations in the BRACA1 and BRACA2 genes. Mutations in BRACA1 and 2 occur in approximately 1 in 200 to 1 in 800 women, respectively.

If a woman carries one of these mutations, their lifetime risk of breast cancer is between 50% and 80%. They also have between an 18% and 40% lifetime risk of ovarian cancer. The diagnosis of these cancers may also occur at younger ages than typically seen.

Surgically removing both ovaries before cancer occurs will decrease the risk of ovarian cancer by 95% and the risk of breast cancer by 50%. Performing a mastectomy will also reduce the risk of breast cancer by over 90%.

Obviously, removal of a woman’s ovaries will render her infertile. This procedure is usually recommended before age 35, or when childbearing is completed. This puts a lot of stress on an individual woman to start and complete her family when she may not be ready, or to have the risk-reducing surgery and forgo reproduction out of fear.

Thus, freezing eggs or embryos may give these patients added piece of mind. When embryos are biopsied and pre-implantation genetic diagnosis (PGD) is performed, we can test and potentially prevent the transmission of the gene mutation.