- A new study finds that a number of young women with breast cancer delay or forgo hormone-blocking therapy due to concerns that treatment might affect their fertility.
- However, there are options for those who wish to protect their fertility and have children in the future.
- Options include cryopreservation, banking of eggs, banking of embryos, and removal and cryopreservation of ovarian tissues.
- Health experts urge women with breast cancer to talk with their doctors about all available options to protect their fertility, and to help make the decision that’s right for them.
For many young women with a diagnosis of breast cancer, deciding which treatments to pursue can be a complicated process.
A new study from the Dana-Farber Cancer Institute finds that a number of young women with breast cancer delay or forgo hormone-blocking therapy due to concerns about how the cancer treatment might affect their fertility.
The findings, which published April 22 in the journal Cancer, highlight the need for people with breast cancer to address their fertility concerns with their physicians, who can provide treatment options that meet their family-planning goals.
Those in this situation who want to prioritize their fertility along with their health and survival face two traumas at once, said Dr. David Seifer, a reproductive endocrinologist at Yale Medicine Fertility Center and professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine.
But there are options to protect fertility.
“The sooner they receive clear information about their own biology and their own reproductive situation, the more likely it is they can realize the options and the potential of fulfilling their hope of becoming a mother,” Seifer said.
Fertility concerns affect cancer treatment decisions
The researchers evaluated 643 women under the age of 40 who had a diagnosis of hormone receptor-positive, stage 2 to 3 breast cancer.
The study excluded those with metastatic breast cancer along with those with stage 0 noninvasive cancer.
The study participants were surveyed every 6 months for 3 years, then annually, about their medical history, current medications, fertility concerns, and endocrine therapy decisions.
The study found that a third of participants with breast cancer said fertility concerns affected their decision to start or forgo endocrine treatment within the first 2 years of diagnosis.
Forty percent who had concerns about fertility decided to forgo or stop endocrine therapy. Of those who had concerns about fertility, 66 percent tried to get pregnant in the first 2 years after diagnosis.
Twenty percent of participants who did not have concerns about fertility stopped or never started endocrine therapy.
How treatment affects fertility
Treatment for cases of hormone receptor-positive breast cancer typically involves surgery, chemotherapy, and endocrine therapy, which comes in the form of a pill, for 5 to 10 years.
According to Dr. Rachel Greenup, the chief of breast surgical oncology at Yale Cancer Center/Smilow Cancer Hospital, both chemotherapy and endocrine therapy can affect fertility.
Chemotherapy can diminish the ovarian reserve, but the severity depends on age at diagnosis and the specific treatments received.
Younger people, for example, are more likely to regain regular ovarian function and menstruation than those in their late 30s and 40s, according to Greenup.
Endocrine therapy intentionally manipulates the hormones, explains Greenup, and impedes ovarian function.
“They’re not really seeing eggs with monthly cycles and they’re unable to carry a pregnancy,” Greenup said.
Supporting family goals during recovery
What are the best options if you want to prioritize fertility while receiving breast cancer treatment?
“That’s the million dollar question,” Greenup said.
Ideally, at diagnosis, premenopausal people will be referred to a fertility specialist or onco-fertility team to discuss their options for fertility preservation.
“They should meet with a reproductive endocrinologist and discuss the possibility of egg or embryo cryopreservation, and part of that evaluative process will be assessing their current ovarian reserve (biological clock) by testing their blood anti-Mullerian hormone (AMH) level,” Seifer said.
There are various options available, such as cryopreservation, banking of eggs, banking of embryos, and removal and cryopreservation of ovarian tissues.
Certain strategies during chemotherapy can protect fertility too. For those taking endocrine therapy, there may be an opportunity to pause it to start a family.
Future research will potentially provide even more options
Researchers involved in the Dana-Farber Cancer Institute study are also researching if and how young women with breast cancer can safely pause endocrine therapy to have children.
This second study is allowing participants to take 18 to 30 months of endocrine therapy, pause for up to 2 years for pregnancy and breastfeeding, then resume the treatment again.
The most meaningful benefits from endocrine therapy typically occur within the first year in a half to 2 years, said Greenup.
The results from this study are expected to be published in the next 6 to 12 months.
“Historically, clinicians discouraged young women to forego pregnancy in order to remain on endocrine therapy. A key finding of the young women’s study was that many young breast cancer survivors were never starting or pausing recommended treatment for pregnancy, and we needed to find a way to support our patients through these personal goals,” Greenup said.
The bottom line
A new study finds that a number of young women with breast cancer delay or forgo hormone-blocking therapy due to concerns about how the cancer treatment might affect their fertility.
The findings highlight the need for people to address their fertility concerns with their physicians, who can provide treatment options that meet their family planning goals.
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