Fertility after Breast Cancer
Young women who are diagnosed with breast cancer must contend with some issues that older women can avoid. The most difficult one usually is related to fertility. Will chemotherapy and hormone therapy end a woman's menses and fertility? (answer: depends on her age and other individual factors) Would a future pregnancy be dangerous vis a vis a possible breast cancer recurrence? (answer: the current medical thinking is that this is usually not a major risk as long as she waits a "safe" period of time after cancer before trying to be pregnant. There are, of course, variables and exceptions. Very much a "talk to your doctors" question.) Will it be more difficult to achieve a pregnancy? (answer: maybe) Will be be scary to consider a pregnancy and having a child when worried about cancer recurrence? (definite answer: yes)
Armstrong and colleagues at the University of Manchester in the UK recently presented a study looking at the attitudes of beliefs of young women with these concerns. Here is a summary:
The conflict between survival and fertility post breast cancer treatment - attitudes and beliefs of young women with breast cancer
Citation: European Journal of Cancer Supplements Volume 8, No.3, March 2010 page 77
A.C. Armstrong 1, A. Wakefield 2, S. Foy 3, S.J. Howell 3
1 The Christie NHS Foundation Trust, Dept. of Medical Oncology, Manchester, United Kingdom
2 University of Manchester, The School of Nursing Midwifery and Social Work, Manchester, United Kingdom
3 The Christie NHS Foundation Trust, Dept. of Medical Oncology, Manchester, United Kingdom
Background: The use of chemotherapy and hormone treatments in young women with breast cancer carries significant implications for their fertility. Increasingly, nulliparous women experience fertility dilemmas due to rising survival rates and the trend for pregnancy delay. This qualitative study investigated women's responses to being told that treatments affected their fertility and their attitudes towards fertility options. In addition, it examined how health services impacted on their experiences.
Methods: Twenty-four women with early stage breast cancer, who were under 40 at diagnosis and who were fluent in English participated in 3 focus groups. Seven participants had attended specialist fertility services as part of their management. A semi-structured interview was also conducted with one participant. Focus groups lasted 1.5 hours, with a question schedule loosely based around themes generated by literature review. Discussions were transcribed verbatim and data analysed using content analysis. Participants were subsequently asked to member check the themes generated.
Results: The priority for most participants was survival, although women without children were more willing to take risks. The women felt that the cancer and its treatment had robbed them of their choice regarding fertility decisions. They worried that changes to treatment in order to reduce its impact on fertility, pregnancy post breast cancer and methods of egg harvesting carried a significant risk to survival. Anxiety appeared to be increased by inconsistent and contradictory advice from health professionals. Those who had attended specialist fertility services were more likely to have had objective advice and had greater confidence that they were making informed decisions.
Conclusions: Young women with breast cancer face complex decisions regarding their fertility and treatment options. Survival remains the most important priority for the majority of women. Although there is a paucity of evidence concerning many fertility issues, it is essential that women are fully informed of options available to them and any potential risks involved in a coherent, objective fashion. Specialist fertility services are an important means of maximising fertility choices for these young women.