Ask Dr. Renee: How Does Having Breast Cancer Affect Fertility?
Breast cancer diagnosis is no longer a death sentence. Unfortunately Black women are being diagnosed at younger ages. Blackwomen under the age of 40 are more likely to develop breast cancer than White women in the same age bracket. As if receiving a breast cancer diagnosis was not enough to worry about, now you have to worry about whether you will be able to ever have children once you become a survivor.
More than 11,000 women under the age of 40 are diagnosed with breast cancer in the U.S. each year. How breast cancer treatment affects fertility depends largely on three factors: the type of treatment used, type and stage of the cancer at diagnosis, and the age of the patient.
Type of Treatment
If your breast cancer can be treated with surgery and radiation and no chemotherapy there is no affect on your fertility. The women that are treated with chemotherapy have a greater risk of developing premature ovarian failure or very early menopause. Cyclophosphamide, one of the most common chemotherapy drugs used to treat breast cancer, has a 40-80% risk of causing women to develop ovarian failure.
Type and Stage of Cancer
The severity of the cancer upon detection, as well as what type of cancer it is, decide whether chemotherapy will be required to treat the disease. The more advanced the cancer is upon detection, increases the likelihood that chemotherapy will be the treatment of choice. Chemotherapy drugs affect the whole body, which is why there are so many side affects when taking these medications. A small tumor with small nodes that are localized and have no threat of spreading (metastasizing) can be surgically removed and radiation administered to make certain they are all gone. Compared to invasive breast cancer which will require chemotherapy.
There are different types of breast cancer tumors, which will also dictate which treatment is best. Some tumors can be treated with hormone-containing drugs. There are a small number of tumors that are “hormonally insensitive,” meaning you can not treat them with hormones so your only treatment option is chemotherapy.
Age of Patient
Age is a major factor in a woman’s fertility. If you are diagnosed with breast cancer and you are already 30 your fertility was already declining. Now, you add the fact that you are taking chemotherapy drugs and have to wait a few more years after you are medically cleared to try to get pregnant. Many times chemotherapy sends women close to 40 into menopause.
Recently I talked about whether or not you “should freeze your eggs.” Many of those methods are recommended to patients who want to preserve their fertility until after they are cancer free. If you have a partner you could try invitro fertilization (IVF) where your partner’s sperm fertilizes your eggs and they freeze the embryos for transplantation into your uterus at a later date.
It is rare for men to get breast cancer, but it happens. Male breast cancer patients that undergo chemotherapy and want to preserve their fertility can freeze their sperm.
Tamoxifen, a drug traditionally used to prevent breast cancer reoccurrence, was recently found to stimulate ovaries in breast cancer survivors during an IVF cycle, enhancing both egg and embryo production. This extra boost can combat infertility barriers such as age and the diminishing ovarian reserves, which occurs naturally with aging.
When Can I Try To Conceive?
Women that are fertile after their breast cancer treatment are generally told to wait two years before trying to get pregnant. The most serious relapses occur in the first two years. During pregnancy the hormone levels are so high that it could possibly contribute to a growing cancer tumor, which is why it is so important to wait at least two years before trying.
Science has come a long way and is still doing lots of research to figure out how to preserve male and female fertility during breast cancer treatment. If you are diagnosed with breast cancer and you plan on having a family, I would recommend you have this discussion with your doctor immediately and ask for a recommendation for a reproductive endocrinologist. The oncologist and reproductive endocrinologist will have to work together to determine what is the best avenue for you to have a baby.
Dr. Renee Matthews has appeared on television shows such as “The Oprah Winfrey Show” and WGN’s “People to People” where she discussed different health topics. She started her media career with her own radio show on Sirius XM/ReachMD, a programming source for health professionals. In addition Dr. Renee has been a featured medical correspondent on Sirius XM’s “Sway in the Morning.”
Dr. Renee earned her undergraduate degree in 1999 and her Medical Doctorate in 2005. She spent the early part of her medical career as an educator for numerous hospitals and attending staff on cord blood.