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Young Women and Breast Cancer: Preserving Fertility

Important Considerations When Deciding on a Cancer Treatment

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Updated September 30, 2008

(LifeWire) - Karen Eggers was diagnosed with breast cancer when she was 38 -- a time so brimming with commitments to career and marriage that to slow everything down for cancer treatment seemed an unbearable sacrifice.

A physical deceleration, though, was essential so the Atlanta resident could undergo a mastectomy, radiation and chemotherapy. An emotional assessment was needed as well, since Eggers hadn't yet had children but didn't want to lose the opportunity.

Due to the toxic nature of the drugs involved, chemotherapy often affects fertility. It targets fast-growing cells, such as those found in malignancies but also in processes such as hair growth and sperm and egg production.

Chemotherapy increases the risk of infertility – a risk that can differ depending on age, medications, dosages and other factors. It can also cause premature ovarian failure, which is menopause that begins before age 40.

"The issue was huge for me," says Eggers, now 45 and a seven-year cancer survivor who is still trying to conceive. "But I had to push for it because a lot of doctors don't 'go there' with you."

About 24,000 of the 240,000 women diagnosed each year in the United States are younger than 45, and roughly 2% are under the age of 35, prime childbearing years. Before they get treatment, these young women must confront personal decisions quite differently from those faced by their older counterparts, among them, how to care for small children and manage careers.

The biggest issue, though, may be whether to attempt to preserve fertility while enduring life-saving therapies. Since there are now 2.4 million breast cancer survivors in the United States alone, this focus on potential new life amid serious illness signals increased optimism that comes from higher survival rates.

"For young adults with cancer, the threat or experience of infertility may be a particularly distressing consequence of cancer diagnosis," writes Ann H. Partridge of the Dana-Farber Cancer Institute in Boston in a 2008 article in Journal of Clinical Oncology. "Many young women with breast cancer struggle with the competing interests of optimizing personal survival and the powerful desire to have a future biologic child."

A new medical discipline, oncofertility, is emerging out of this concern. At least 50 U.S. medical centers now provide services to young cancer patients that include egg preservation and harvesting as well as egg and embryo freezing.

Either way, this push has included a National Institutes of Health grant of $21 million – the first of its kind – in 2007 to Northwestern University's Feinberg School of Medicine. The grant funds an initiative to protect the fertility of women undergoing chemotherapy or radiation.

Some studies have suggested that oncologists do not spend enough time discussing treatment-related infertility with patients. As a result, the American Society of Clinical Oncology (ASCO) issued a set of recommendations in 2006 concerning available fertility preservation methods.

ASCO advised physicians to talk with cancer patients before treatment starts about possible fertility concerns and to quickly follow up with referrals to specialists if patients desire to preserve their ability to have children.

While past estrogen-receptor positive breast cancer patients may want to really consider if it is wise to get pregnant, other women can now benefit from an increasing array of options that can help conceive, including:

  • Egg freezing: This experimental treatment has not yet had more than limited success because eggs are so fragile during the freezing-thawing process. It is a logical choice for women who don't yet have a partner with whom to conceive and who do not want to use donor sperm. The ovaries are stimulated with medication designed to spur the release of many eggs. These eggs are then frozen for future use. The process takes two to six weeks.
  • Embryo freezing: This option is a much more reliable method of preserving fertility than egg freezing. Pregnancy rates of 10 to 25% have been recorded per embryo transfer in to a woman. Medication stimulates the ovaries to release many eggs. Once removed, the eggs are fertilized with sperm from a partner or donor and the resulting embryos are frozen for future use. The entire process takes between two and six weeks.
  • Ovarian tissue freezing: Freezing ovarian tissue is a good option for patients who can't spare weeks for ovarian stimulation before they begin cancer treatment. Doctors take out one or both ovaries in an outpatient procedure and divide them into strips, which are frozen. The tissue can later be re-implanted and begin producing hormones and mature eggs again. It should be said, though, that this ovarian tissue freezing is very new and the success rates of this kind of procedure aren't well-defined.

Even during chemotherapy, there are steps women can take to protect fertility, including a hormone treatment that prompts the ovaries to temporarily stop functioning in the hope of reducing damage to the follicles where eggs develop. Sometimes called "chemical menopause," this was the treatment Karen Eggers underwent.

"I've been able to try for a baby since last summer," she says. "Now I'm ovulating, and everything is working, it seems."

Sources:

"Breast Cancer and Fertility." Fertile Hope, New York, N.Y.

"Breast Cancer Facts and Figures 2007-2008." Cancer.org. American Cancer Society, Atlanta, Ga.

Eggers, Karen. Atlanta, GA. Telephone interview, 2 July 2008.

Lee, S.J., L.R. Schover, A.H. Partridge, P. Patrizio, W.H. Wallace, K. Hagerty, L.N. Beck, L.V. Brennan, and K. Oktay. "American Society of Clinical Oncology Recommendations on Fertility Preservation in Cancer Patients." Journal of Clinical Oncology 24:1820 Jun. 2006 2917-2931.

"Northwestern University Awarded $21M Grant to Develop Methods Aimed at Protecting Fertility of Women Undergoing Radiation, Chemotherapy." Medicalnewstoday.com. 12 Sep. 2007. Medical News Today. 29 Jul. 2008.

Partridge, A.H. "Fertility Preservation: A Vital Survivorship Issue for Young Women with Breast Cancer." Journal of Clinical Oncology. 26:161(2008): 2612-13.

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Maureen Salamon is a New Jersey-based freelance writer who has written for newspapers, websites and hospitals.
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