Breast Cancer and Fertility
Being told that you have breast cancer can be overwhelming. Being told that you have breast cancer while still in your childbearing years and planning on starting your family can be devastating. While receiving treatment for breast cancer is vitally important, affects of the treatment may make you worry about your fertility health.
What is Breast Cancer?
When cells inside your body begin to multiple and mutate out of control, cancer occurs. In the case of breast cancer, your breast cells multiple too quickly causing tumors to form deep within your breast. Unfortunately, what causes these cells to grow to such excess is unknown. Without treatment, these cells continue to grow, spreading throughout your body, resulting in various side effects and ultimately death.
Breast cancer is the most common form of cancer to affect women. Although it is generally thought to develop in women over the age of 50, one in four women diagnosed with breast cancer will be under the age of 50 and in their childbearing years. 216,000 people in the United States will be diagnosed with breast cancer this year. While breast cancer is almost exclusively associated with women, one in every 100 patients is male.
Will Breast Cancer Affect My Fertility?
As with most types of cancer, receiving treatment will make an impact on your fertility. These effects may be temporary or they may be permanent. The degree to which your fertility will be impacted depends on a number of factors including the type of treatment you receive, the dosage of drugs you may receive and your age. Chemotherapy is particularly known for causing fertility problems.
Women over the age of 40 are more likely to permanently lose their fertility because their fertility has already begun to decline. Unfortunately, though, there is no way to know for sure in advance just how breast cancer treatment will affect your fertility.
Chemotherapy
Although surgery is a common treatment for breast cancer, many women will require chemotherapy to kill off their breast cancer tumors. Chemotherapy works by utilizing various drugs to destroy the cancer cells and hinders the division of the cells. While it is an effective form of treatment, it is also the treatment most likely to damage your fertility.
While there are different types of chemotherapy drugs, those that fall into the ‘alkylating agents’ group, particularly cyclophosphamide, are the most likely to cause fertility problems. Because estrogen plays a role in the development of breast cancer, part of the chemotherapy’s role in treatment is to interfere with the production of estrogen. As a result, your regular ovulation cycle is interrupted and many of your eggs may be killed off. Additionally, it is very common for women undergoing chemotherapy to experience amenorrhea, which may be temporary or permanent.
Chemotherapy has also been known to cause premature menopause in some women. However, this does not necessarily occur immediately after finishing chemotherapy. This means that ovulation may still occur between the end of chemotherapy and the start of menopause. Once you go through menopause, though, you will no longer be able to have children.
In an effort to preserve the fertility of women undergoing chemotherapy, some doctors have begun using injections of the drug triptorelin to temporarily shut down the ovaries. By doing this, it is hoped that minimal damage will occur to the ovaries. This treatment is still somewhat experimental, though, and has not been studied on a large scale.
Other Breast Cancer Treatments
In some women, the growth of cancerous cells is found to be more sensitive to estrogen (a condition known as estrogen receptor positive). In these instances, it is necessary to prevent the ovaries from functioning properly thereby decreasing the amount of estrogen naturally produced in the body. This is called ovarian ablation. Three different methods may be utilized to stop ovarian function:
- Radiation Therapy: This treatment destroys your eggs thereby making the ovaries permanently dormant. Partial fertility may be preserved if this treatment is only required on one side of your ovaries.
- Surgery: When necessary, surgery to remove your ovaries may also be done. This will result in the permanent loss of your fertility.
- Hormone Treatment: Use of hormonal injections will temporarily inhibit the function of your ovaries. This type of treatment may be able to help preserve your fertility although it can take up to six months for your periods to return after stopping treatment.
After Breast Cancer Treatment – Now What?
While treatment for breast cancer may hamper your fertility, all women should assume that they are fertile until proven otherwise. In general, many women experience no fertility problems whatsoever so long as they did not receive chemotherapy. If you fail to have any periods for a year after a treatment, though, make an appointment for a fertility workup to make sure everything is okay.
Once you have finished your initial treatment for breast cancer, you will likely have to take an estrogen-inhibiting drug for five years. This is to help prevent breast cancer from developing again. Women in their reproductive years are typically given tamoxifen. While this drug has been shown to stimulate ovulation, thereby making a woman more fertile, it can also cause you to have irregular periods. In some women, periods may become lighter or stop altogether.
Common side effects of tamoxifen are often similar to menopausal symptoms and include hot flashes and cessation of periods. Although this drug does not cause menopause to start, it can hide the symptoms of natural menopause. If you have gone through naturally occurring menopause while using this drug, you may not realize it until you discontinue the use of tamoxifen.
Five years is a long time to put off having children, particularly for women who were hoping to start their family before they were diagnosed with breast cancer. However, because there is less chance of cancer returning the longer you wait, it is generally recommended that women wait at least two years before they start trying to conceive. Additionally, though tamoxifen can make you more fertile, use of the drug can cause problems in a developing fetus. Therefore, tamoxifen should not be used during pregnancy.
If you are interested in pursing pregnancy before the recommended five years of tamoxifen treatment is up, speak with your doctor. It may be possible to temporarily stop taking the drug to allow for pregnancy. However, you should never discontinue the medication without your doctor’s approval first.
Preserving Fertility
Women who have been diagnosed with breast cancer may take a number of actions to increase their chances of becoming pregnant after treatment.
- The most effective preventative measure is to start IVF before cancer treatment. This would involve collecting your eggs and combining them with your partner’s sperm in order to produce embryos. These embryos would then be frozen and implanted once you have completed treatment.
- Another option that some women choose is to have their eggs frozen. However, this technology has not yet been perfected and less than 200 children have been born world-wide using cryoperserved eggs.
- When breast cancer treatment must be started right away, some women decide to have part of their ovarian tissue removed and frozen in order to be re-implanted once treatment has been completed. This method of preserving fertility is still very new and regarded as experimental with very few children having been born this way.
Affects of Pregnancy on Breast Cancer
One concern for many women who have dealt with breast cancer is how pregnancy will impact their chances of developing cancer again. During pregnancy, it is normal for hormone levels to increase. While this generally causes few problems, women who are worried about a recurrence of breast may be a bit anxious at the thought of having excess amounts of estrogen in their system. However, there is no evidence to suggest that pregnancy increases a woman’s chances of breast cancer returning.
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