Most Not Preserving Fertility Before Breast Cancer Treatment
When first diagnosed with breast cancer, many young women are concerned about how treatment might affect their future fertility, or ability to have children.
Yet a recent study published in the Journal of Clinical Oncology showed most do not change care plans due to that concern. Few take steps to preserve fertility before starting treatment that may damage the ovaries or cause menopause to start sooner.
Background and Reason for the Study
Breast cancer treatment can create fertility problems for women who still get their periods. Chemotherapy may damage the ovarian sacs that release eggs, causing early menopause or infertility. Tamoxifen, taken according to standard schedules (for 5 or 10 years), can delay future pregnancies and also hasten menopause. Women who want to become pregnant after treatment have to consider the effects longer aging may have on their ability to do so.
Some studies suggest young women diagnosed with breast cancer have more distress than do older women. Concern about treatment effects on fertility may be one factor adding to their distress.
Researchers wanted to learn how concerned young women were about treatment-related infertility when first diagnosed. They also wanted to find out whether such concerns affected women’s decisions to preserve fertility or about breast cancer treatment options.
Information was drawn from an ongoing study of women who were age 40 or younger when diagnosed with breast cancer. Women in this study were diagnosed with stage 0 to III breast cancer no more than 6 months before enrollment.
A total of 620 women from 11 locations in Massachusetts and one in Colorado took part in the study. Each answered a mailed survey with questions about fertility concerns and decision-making. Answers were analyzed along with data from medical records.
The women were mostly white (88 percent); 3 percent were black and 7 percent were Asian. They were largely college educated (84 percent) and married (76 percent). Among them:
- 66 percent had children before diagnosis
- 25 percent were never pregnant
- 99 percent were medically insured
Most (68 percent) discussed fertility issues with their doctors before starting treatment. They described their level of concern about becoming infertile as very (24 percent), somewhat (14 percent), a little (13 percent), and not at all (49 percent) concerned.
Women with greater concern were likely to have one or more associated factors including: receiving chemotherapy, being younger than 35 years old, identifying as nonwhite, and not already having children.
Fertility concerns affected treatment decisions for 26 percent of the women. Among specific decisions cited, they
- chose to not receive chemotherapy – 1 percent
- opted for one chemotherapy regimen over another – 2 percent
- chose to not receive hormonal therapy – 3 percent
- considered hormonal therapy for less than the standard 5 years – 11 percent
- underwent mastectomy – 1 percent
- It is possible these women had DCIS and chose breast removal to avoid having to take tamoxifen, which would delay pregnancy.
Only 10 percent of all women (27 percent of nonwhite women, 9 percent of white women) took steps to preserve fertility before breast cancer treatment.
Most choosing fertility preservation underwent embryo cryopreservation, or freezing. During chemotherapy, some received GnRH-a, a medicine believed but not proven to protect ovarian function. A few women had oocyte cryopreservation, or freezing of their eggs. This is a newer technique, with few documented cases of live births using stored oocytes, but is becoming more available.
What This Means for You
Before breast cancer treatment begins, talk frankly and clearly with your oncologist about how treatments might affect your fertility and future pregnancies. If your doctor does not bring up this topic, it’s OK to do so yourself. Know there are often steps you can take before treatment to protect your ability to conceive.
Ask to see a reproductive endocrinologist with experience treating women with cancer. See this specialist early, before treatment starts. Your oncologist should be able to recommend someone. Otherwise, you can contact the Society for Reproductive Endocrinology and Infertility to find specialists near you. If you already had some or all of your breast cancer treatment, a reproductive endocrinologist can help determine your fertility health and options.
Ruddy KJ, Gelber SI,Tamimi RM et al. Prospective study of fertility concerns and preservation strategies in young women with breast cancer. Journal of Clinical Oncology. 2014; doi:10.1200/jco.2013.52.8877
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.