Breast Cancer: How it Affects Fertility (cont.)
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, notes Oktay.
Although males rarely develop breast cancer, it does happen. For male breast cancer patients who must undergo chemotherapy and want to preserve their fertility, freezing sperm is an effective option. "Since there are millions of sperm, even if you kill half in the freezing process, you still have a lot left," Barbierri explains.
Researchers' focus on fine-tuning methods of fertility preservation fuel optimism about its increasing viability. "A decade ago, there was practically no emphasis on fertility preservation. Today, there are several methods and thus a much greater potential," Oktay tells WebMD.
Conception Concerns: Relapse, Harm to Offspring
For survivors who remain fertile, questions about conception remain. Relapse is one of them.
"A common clinical recommendation is that a survivor wait two years before attempting to become pregnant, since most serious relapses will occur within the first two years after treatment," Barbierri tells WedMD. "If you wait two years, there's no strong evidence that pregnancy will influence the course of disease."
Survivors also worry that their offspring will be at risk for cancer. According to experts, that risk is small. "Only 5% of breast cancers are truly inherited via a specific genetic mutation," Domcheck tells WebMD. "If you have an inherited genetic mutation, you have a 50-50 chance of passing it on to your children." To date, researchers have identified a few genetic mutations that contribute to breast cancer; these include BCRA-1 and BCRA-2.
What is the prognosis for offspring who do inherit one of these genetic mutations? "There does not appear to be an increased risk of childhood cancers. However, these children are at a slightly higher risk for developing ovarian and breast cancers," Domcheck says.
But genetics are only part of the picture.
"It's likely that an interplay between a collection of genes, when added to certain environmental factors, results in breast cancer," Domcheck says. Known environmental risk factors include moderate or heavy drinking (for women, two or more drinks per day), having children later in life, and obesity.
Survivors also question the impact of cancer treatment on future offspring. The news on this front is very encouraging. "There does not seem to be any increased risk of birth defects if the woman who's gone through breast cancer treatment gets pregnant. Even if the woman gets chemotherapy during pregnancy, fetuses do surprisingly well," Domcheck tells WebMD.
Addressing Fertility With Your Doctor
Absorbing news of a breast cancer diagnosis as well as focusing on how it might affect future fertility can be overwhelming. But because oncologists are trained to provide the best cancer treatment available -- not necessarily in light of fertility options -- patients interested in seeking information on fertility need to be proactive.
"A patient needs to say to herself, 'What do I want in the future' and ask the doctor, 'What's this [treatment] going to do with my future plans for fertility?'" says Ann Partridge, MD, MPH, breast oncologist and instructor at Harvard School of Medicine in Boston.
Others agree. "You need to have as much information as possible," says Karen Dow, PhD, RN, professor at University of Central Florida's School of Nursing. She suggests getting a third or even fourth opinion, ideally from doctors in different specialties -- oncology, reproductive endocrinology, gynecology -- since each will bring a unique perspective unique to the table.
"It would be wonderful if, in the future, doctors would all come together to say, 'Hey, here's what's out there, here's what it means to you,'" Dow says. But for now, it's up to the patient to seek information on her options, as early as possible.
Published Sept. 27, 2004.
SOURCES: Robert Barbierri, MD, chief, obstetrics and gynecology, Brigham and Women's General Hospital, Boston. Kutluk Oktay, MD, assistant professor, reproductive medicine and obstetrics and gynecology, Cornell's Center for Reproductive Medicine and Infertility, New York. FertileHope web sit. Susan Domcheck, MD, assistant professor of medicine, University of Pennsylvania. Ann Partridge, MD, MPH, breast oncologist and instructor, Harvard School of Medicine, Boston. Karen Dow, PhD, RN, professor, University of Central Florida's School of Nursing, Orlando, Fla.
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