All women diagnosed with breast cancer have many decisions to make. If you’re a young woman who wants to get pregnant and have children in the future, the medical decisions are even more complex.
A study suggests that while most young women diagnosed with breast cancer are concerned about fertility issues, few of them change their treatment plans to preserve fertility. Fewer still take advantage of fertility preservation options, including freezing eggs or embryos.
The researchers said that the results imply that doctors and patients aren’t communicating clearly about the factors that affect fertility and options for fertility preservation.
The study was published online on Feb. 24, 2014 by the Journal of Clinical Oncology. Read the abstract of “Prospective Study of Fertility Concerns and Preservation Strategies in Young Women With Breast Cancer.”
Doctors know that many diagnosed women have fertility concerns. But because each woman’s situation is unique, studying fertility in women who have been diagnosed isn’t easy. Most research on fertility in young women diagnosed with breast cancer has focused on long-term survivors (women who were diagnosed and treated more than 5 years earlier). In this study, the researchers wanted to know if fertility concerns affected breast cancer treatment decisions made by younger women. The researchers also wanted to know how many women used fertility preservation techniques.
Many breast cancer treatments, including hormonal therapy, chemotherapy, and targeted therapies, can cause temporary infertility or make it harder for you to get pregnant after treatment ends. Some treatments, such as surgically removing the ovaries, cause permanent, irreversible infertility.
The American Society of Clinical Oncology (ASCO), a national organization of oncologists and other cancer care providers, recommends that doctors talk about fertility issues with all younger women who are diagnosed with breast cancer. ASCO guidelines also recommend that doctors refer interested women to fertility specialists to discuss options for fertility preservation. It’s not clear how many doctors follow these guidelines. Earlier studies have shown that many younger women have fertility concerns but don’t receive enough information about fertility risks or fertility preservation options from their doctors.
In this study, researchers at the Mayo Clinic in Rochester, Minn., surveyed 620 women 40 or younger who had been diagnosed with breast cancer from 2006 to 2012. The women were surveyed within 6 months of their diagnosis.
The surveys included questions about:
- whether or not the women wanted to have children in the future
- fertility risks
- fertility preservation options
- treatment choices
- whether or not their doctors had talked to them about fertility issues
The women ranged in age from 17 to 40 years old. Most of the women were white, married, and had children living at home when they were diagnosed.
The researchers found that:
- 233 women (37%) wanted to have one or more children in the future
- 424 women (68%) said they had discussed fertility issues with their doctors before starting breast cancer treatment
- 301 women (49%) weren’t concerned about becoming infertile
- 83 women (13%) were a little concerned about becoming infertile
- 88 women (14%) were somewhat concerned about becoming infertile
- 148 women (24%) were very concerned about becoming infertile
This means that 51% of the women in the study were at least a little concerned about becoming infertile because of breast cancer treatment. Women who were younger than 35, not white, and didn’t have any children were the most concerned about becoming infertile.
The researchers also found that 160 women (26%) said that concerns about fertility affected their breast cancer treatment decisions. About 90 of these women gave details about their treatment choices:
- 4 women (1%) decided not to have chemotherapy
- 12 women (2%) chose one chemotherapy regimen over another
- 6 women (1%) considered skipping hormonal therapy
- 19 women (3%) decided not to have hormonal therapy
- 71 women (11%) considered taking hormonal therapy for less than 5 years
- 5 women (1%) had preventive mastectomy
Overall, 65 women (10%) took steps to reduce their risk of infertility:
- 46 women (7%) had embryos frozen
- 7 women (1%) had eggs frozen
- 19 women (3%) were treated with a gonadotropin-releasing hormone agonist; this is a medicine that stops the ovaries from functioning during treatment to protect a woman’s eggs
Over time, the number of women who took steps to reduce the risk of infertility went up slightly:
- 5% in 2006
- 9% in 2007
- 12% in 2011
- 15% in 2012
The results of this study are troubling. While more than 50% of younger women diagnosed with breast cancer were concerned about fertility issues, only about 10% took steps to reduce their risk of infertility. This suggests that women and their doctors need to more thoroughly discuss fertility concerns and steps that can be taken to minimize that risk.
If you're a premenopausal woman diagnosed with breast cancer, the ability to have children after breast cancer treatment may be important to you. Still, it's very likely that a breast cancer diagnosis and the need to start treatment as soon as possible 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 to learn about steps you can take to improve your chances of having a child in the future.
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, ask your doctor about steps you can take to preserve your fertility. You also may want to ask for a referral to an infertility 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.