Addressing fertility needs of breast cancer patients: oncology perspective

Abstract

Premenopausal women represent approximately 23% of women diagnosed with breast cancer. As the medial age of first pregnancy increases in developed countries, a greater proportion of women are diagnosed with breast cancer at a time when they have not yet completed their family. For these women, the impact of breast cancer treatment on their reproductive capacity can be of significant concern and may influence their treatment decisions. Despite these concerns only a proportion of premenopausal women with breast cancer are informed about their treatment choices in light of their reproductive needs. The diagnosis of cancer itself as well as systemic cancer treatments, including chemotherapy and hormonal therapy, can delay and/or reduce the reproductive capacity. Treatment decisions need to consider not only adjuvant treatment efficacy but also its risks, including impact on fertility. The risk of chemotherapy-associated amenorrhea varies according to the regime and is age-dependent. Hormonal treatments may delay reproduction further. A variety of fertility preservation strategies have been tried including gonadal protection during chemotherapy, ovarian cryopreservation and in vitro fertilization, but their potential benefits need to be considered in light of risks and, for most of them, the evidence for efficacy is limited. Special fertility considerations are required in women with family history and/or evidence of genetic predisposition to breast cancer as strategies for risk reduction may impact on their fertility choices. Finally, as survival of women with metastatic breast cancer increases, women with advanced cancer who become pregnant pose unique management challenges for oncologists and obstetricians alike.

Keywords::

• breast cancer
• chemotherapy
• fertility
• reproductive technology

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.