Fertility a worry for young breast cancer patients

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Many young women diagnosed with breast cancer overestimate their risk of becoming infertile while undergoing treatment, a new study shows.

While chemotherapy for the disease can indeed affect fertility, Dr. Ann H. Partridge of Dana-Farber Cancer Institute in Boston told Reuters Health, women with breast cancer can take steps to maximize their chances of having a successful pregnancy after treatment.

"Women who develop breast cancer are dealing with a lot of different issues and concerns and anxieties,” she added. “If (fertility) is something that is important to them, they should bring it up at the beginning, as early as they think of it.”

Partridge and her colleagues surveyed 657 young breast cancer patients, 57 percent of whom reported having substantial concerns about infertility.

Most of the women had been diagnosed with breast cancer within the previous two years, and their average age at diagnosis was about 33. Nearly 30 percent reported that their concerns about infertility influenced their treatment decisions.

Half of the women in the study who were 30 or younger estimated that they had a 40 percent or greater chance of becoming infertile during breast cancer treatment, Partridge and her team report in the Journal of Clinical Oncology.

However, 70 percent to 80 percent of the women continued to have normal menstrual periods after breast cancer treatment, the researcher noted.

“An important caveat is that continuing to menstruate does not equate with fertility,” Partridge pointed out. Women who do continue to have their periods after breast cancer treatment may still be less fertile than before, she explained.

The likelihood that chemotherapy will bring on premature menopause in women younger than 30 is actually quite low, according to Partridge.

While 20 percent of women 30 or under given the standard combination of cyclophosphamide, methotrexate and fluorouracil will stop menstruating, studies suggest a newer regimen combining an anthracycline drug such as adriamycin with cyclophosphamide has a zero percent risk of causing premature menopause in women 30 and younger, and a 10 to 15 percent risk for women 40 and younger.

Nevertheless, Partridge said, women who choose the newer regimen will have a lower risk of becoming infertile.

Other measures to guard fertility include banking ovarian tissue, eggs, or fertilized embryos, she pointed out.

Using Lupron to suppress ovulation during breast cancer treatment has been used as a strategy to protect fertility, but it is not yet clear whether this actually works. Studies are underway that should provide a definitive answer to this question, Partridge said.

Women in the survey also reported being concerned about the effect a future pregnancy might have on their prognosis. Extensive studies have not found that pregnancy is harmful for breast cancer survivors, Partridge said, but a recurrence of breast cancer during pregnancy or while caring for a young child would be extremely difficult for many reasons.

“I always caution women to wait at least two to three years, or five years if they want to be really out of the woods,” she advised.

SOURCE: Journal of Clinical Oncology, October 15, 2004

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