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Infertility Risk High After Breast Cancer Treatment

Young women need fertility information, preservation before therapy begins

August 15, 2014

Written By Robin Warshaw
Reviewed By A. Jo Chien, MD

Most young women diagnosed with early-stage breast cancer are at risk of becoming infertile from treatment, according to a study from the Centers for Disease Control and Prevention (CDC) and other researchers.

The investigators noted that doctors should educate women who are younger than 45 about their treatment-related infertility risks before cancer therapy begins.

Background

Chemotherapy can affect fertility in premenopausal women. Chemotherapy destroys ovarian follicles which can reduce ovarian reserve, making women infertile earlier, and lead to early menopause

Hormonal therapy, such as tamoxifen, cannot be used during pregnancy, so women have to avoid becoming pregnant until after treatment. For some, waiting up to 10 years to finish tamoxifen therapy may result in age-related infertility.

For women who are in their reproductive years and want to have a child after breast cancer treatment, fertility preservation before cancer treatment offers several medical approaches to protect future pregnancy.

Studies show that only 4 to 10 percent of women at risk of infertility from cancer therapy take steps to preserve fertility.

Though the American Society of Clinical Oncologists (ASCO) recommends doctors discuss possible infertility early in treatment planning, women often do not hear about fertility risks or preservation options from their cancer doctors. In a 2013 national needs assessment of young women affected by breast cancer, LBBC determined that only half of respondents had a fertility discussion with their healthcare providers.

Reason for the Study

This study was designed to estimate how many women with breast cancer have treatment-related infertility risk and need education from their doctors, as well as the number who might want to become pregnant later. These women should receive fertility counseling and may want fertility preservation before treatment.

Study Structure

Data came from CDC and National Cancer Institute (NCI) cancer registries for women aged 15 to 44, and diagnosed with early-stage breast cancer from 2004 to 2006.

Data also came from CDC studies of breast cancer care and reproductive health. Infertility risk was estimated based on the use of chemotherapy and hormone receptor status. The reproductive health study measured intent to have a child in the U.S. population.

Results

Of the 20,038 young women diagnosed with early-stage breast cancer annually, the researchers estimated 97 percent were at risk of infertility. These women had estrogen or progesterone receptor-positive breast cancer or received chemotherapy. Researchers say this group should be educated on fertility risk by their cancer doctors.

Forty- nine percent of this group was estimated to want children. Age was the strongest predictor of wanting a child. The majority of those wanting children were 40 – 44 years old.

The researchers said all women who want children should have fertility counseling and access to preservation. Though women aged 40 – 44 may be less likely to become pregnant for several reasons, they should still be told about their risks and options.

Doctors need to better understand the scope of infertility risk and fertility preservation services should be more accessible, the researchers added.

What This Means for You

Talk with your doctor about your infertility risk from breast cancer treatment. Ask for a referral to a fertility specialist. You might not know if you want to become pregnant after treatment, but it’s helpful to learn what could happen and how to protect your fertility in advance.

Worried about how to pay for fertility preservation? LIVESTRONG fertility may be able to help with reduced costs for procedures.

Trivers, KF, Fink, AK, Partridge, AH et al.  Estimates of Young Breast Cancer Survivors at Risk for Infertility in the U.S. The Oncologist, 2014; doi: 10.1634/theoncologist.2014-0016

This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

Denver, CO  ·  September 13, 2014

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