Fertility Advice Depends on Race, Education, Economic Status

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Some cancer treatments, including chemotherapy and hormonal therapy, can cause temporary or permanent infertility. Earlier research found that in many cases doctors weren't giving women enough information about fertility problems that could happen because of cancer treatments and weren't referring cancer patients to fertility specialists for counseling before treatment.

A new study found that the likelihood that a woman who's been diagnosed with cancer will get fertility counseling before cancer treatment starts depends on her race, educational background, and economic situation. The results were published on March 26, 2012 in the online edition of Cancer.

Researchers surveyed more than 900 women of child-bearing age diagnosed with cancer (in some cases breast cancer) between 1993 and 2007. The women were age 18 to 40 when diagnosed (average age 32). All the women got one or more cancer treatments that could have caused fertility problems. The survey asked about:

  • aspects of each woman's personal and professional situation
  • whether or not she received information about fertility risks due to treatment
  • whether or not fertility counseling was recommended before treatment

Overall, women were more likely to get fertility counseling and services to preserve fertility before cancer treatment if they were diagnosed more recently. Only 44% of women diagnosed in 1993 received fertility counseling and/or fertility preservation services before treatment compared to 61% of women diagnosed in 2007.

Still, a number of personal factors affected whether a woman got fertility counseling and/or preservation services before treatment. Counseling and preservation services were less likely in women who:

  • didn't attend college
  • had lower household income
  • weren't white
    • Latina women were 80% less likely than white women to have taken steps to preserve fertility before cancer treatment.
    • None of the African American women who answered the survey had received fertility preservation services before cancer treatment.

Younger women were more likely than older women to get fertility counseling and preservation services before cancer treatment. None of the gay, transgendered, or bisexual women who answered the survey reported receiving fertility counseling or services before treatment.

There could be several reasons why many women said they didn't receive fertility counseling and/or preservation services before cancer treatment:

  • disparities in care related to ethnic background and language
  • lack of insurance coverage and/or inability to pay for fertility services
  • doctors' biases about a woman's ability to understand or her interest in treatment-related fertility problems
  • other biases, such as assuming that older women who can still bear children or gay, transgendered, or bisexual women may be less interested in fertility risks

If you're a premenopausal woman who's been diagnosed with breast cancer, the ability to have children after breast cancer treatment may be important to you. Still, it's very likely that breast cancer diagnosis and treatment may push thoughts about future fertility (and many other things) to the back of your mind.

But while you and your doctor are planning your treatment is the best time to figure out how specific treatments might affect your fertility and learn about steps you can take to improve your chances of having a child in the future. For example, eggs from your ovaries can be extracted and stored until your treatment is completed.

If you're about to start breast cancer treatment and being able to have a child in the future is important to you, be sure to tell your doctor. Ask your doctor how any treatments being considered could affect your future fertility. If the treatments that are best for you could cause fertility problems, it's a good idea to ask your doctor about steps you can take to preserve your fertility. You also may want to ask for a referral to a fertility specialist.

You can learn more about breast cancer treatment and infertility issues in the Breastcancer.org Fertility and Pregnancy Issues During and After Breast Cancer pages.

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