Breast Cancer and Fertility: What are my Options?
- 10% of breast cancer cases occur in women younger than 45 years of age.
- A higher percentage of women who underwent fertility preservation had at least 1 post-breast cancer birth (22.8%) versus those who did not undergo fertility preservation (8.7%).
- Those who had undergone fertility preservation had a more than 2-fold higher rate of live births after diagnosis.
- The all-cause mortality rate was lower in women exposed to fertility preservation versus women who were not.
Marklund A, Lundberg FE, Eloranta S, et al.
Reproductive Outcomes After Breast Cancer in Women With vs Without Fertility Preservation.
JAMA Oncol. 2020 Nov 19:e205957. doi: 10.1001/jamaoncol.2020.5957.
Interestingly, about 10% of breast cancer cases occur in women younger than 45 years of age. It is important to recognize that about half of young women with breast cancer desire pregnancy after completion of their breast cancer therapy. However, their chances of pregnancy post-treatment are 40-60% lower than the general population. With improved survival for these young breast cancer patients it is important to discuss fertility and production with these patients. Currently, fertility preservation includes cryopreservation of oocytes and embryos after controlled ovarian stimulation. Fertility preservation can be costly and anxiety producing — especially at the time of a new cancer diagnosis. Therefore, there has been an increasing need for accurate information on the chances of pregnancy both with and without the help of fertility perseveration.
Marklund et al conducted a cohort study that looked at long-term reproductive outcomes of women with breast cancer who underwent fertility preservation versus women who did not undergo fertility preservation. A higher percentage of women who underwent fertility preservation had at least 1 post-breast cancer birth (22.8%) versus those who did not undergo fertility preservation (8.7%). In this study, those who had undergone fertility preservation had a more than 2-fold higher rate of live births after diagnosis. However, use of assisted reproductive technology was also higher in the fertility preservation cohort. Also, women with fertility preservation were more likely to have more than one child after diagnosis. Surrogacy was not used in this study as it is illegal in Sweden where this study was conducted. The all-cause mortality rate was lower in women exposed to fertility preservation versus women who were not. It is important to recognize that in this Swedish study successful pregnancy was possible in women both with and without fertility preservation.
So what does this mean for our breast cancer patients? It is important to discuss fertility preservation with your doctor as part of your breast cancer treatment plan. This study also shows promising long-term reproductive outcome for women diagnosed with breast cancer at an early age with or without fertility preservation. However, a limitation of this study was that it did not account for childbearing intent at the time of breast cancer diagnosis. Therefore, the data may be misleading as women who had a stronger desire for childbearing may have been more likely to pursue fertility preservation at the time of breast cancer diagnosis. It is important to note that current data suggests that fertility preservation is association with a higher rate of post-breast cancer live births without an effect on all-cause survival. Fertility preservation is potentially a safe and effective option for many women in the setting of a breast cancer diagnosis.