{"id":26629,"date":"2020-12-22T12:00:00","date_gmt":"2020-12-22T12:00:00","guid":{"rendered":"https:\/\/www.cancer.gov\/news-events\/cancer-currents-blog\/2020\/breast-cancer-fertility-preservation-safe"},"modified":"2024-11-03T15:15:50","modified_gmt":"2024-11-03T15:15:50","slug":"fertility-preservation-safe-for-young-women-with-breast-cancer","status":"publish","type":"post","link":"https:\/\/ogkologos.com\/en\/fertility-preservation-safe-for-young-women-with-breast-cancer\/","title":{"rendered":"Fertility Preservation Safe for Young Women with Breast Cancer"},"content":{"rendered":"

\n
\n
\"Laboratory<\/div>
\n
\n

Collecting eggs from a woman and creating fertilized embryos for storage may delay some parts of cancer treatment.<\/p>\n

Credit: iStock<\/p>\n<\/div>\n<\/figcaption><\/figure>\n<\/div>\n

Common methods of preserving a woman\u2019s fertility before starting breast cancer treatment are safe for young women, according to a large study that tracked Swedish women for more than 2 decades.<\/p>\n

About 6% of the women who chose to freeze their embryos, eggs, or ovarian tissue before undergoing treatment for breast cancer died over the 23 years covered by the study. During the same period, 13% of matched women who didn\u2019t undergo fertility preservation died, according to the study results<\/a> published on November 19 in JAMA Oncology<\/em>.<\/p>\n

For several reasons, such as age and breast cancer risk, direct comparisons between these two groups are difficult to make, explained Emily Tonorezos, M.D., director of NCI\u2019s Office of Cancer Survivorship<\/a>.<\/p>\n

\u201cBut at the same time, this is very reassuring evidence about survival\u201d after fertility preservation and childbirth, Dr. Tonorezos said.<\/p>\n

Only 9 out of 425 women in the study who underwent fertility preservation\u2014about 2%\u2014later used their banked embryos, eggs, or ovarian tissue.<\/p>\n

But, given the large number of women diagnosed with breast cancer every year, \u201cthat\u2019s clinically meaningful, especially as there\u2019s no downside in terms of survival,\u201d said Jennifer Levine, M.D., who specializes in fertility after cancer treatment at Weill Cornell Medicine and New York-Presbyterian and was not involved in the current study.<\/p>\n

\u201cIn my mind, that makes the case that these procedures should be considered a standard part of treatment for those who want it,\u201d she said.<\/p>\n

Residual Concerns about Risk<\/h2>\n

Studies have found that about half of young women with breast cancer say they would like to have a child after completing treatment. But some treatments for breast cancer, such as certain types of chemotherapy, can cause infertility.<\/p>\n

Fertility preservation after a breast cancer diagnosis can be complicated. While men can bank sperm quickly, collecting eggs from a woman and potentially creating fertilized embryos for storage (via cryopreservation<\/a>) requires delaying some parts of cancer treatment for weeks or months.<\/p>\n

In addition, methods used for preserving fertility at diagnosis\u2014and then later in assisted reproductive technology (including in vitro<\/em> fertilization<\/a>, or IVF) to conceive\u2014involve the use of hormones that cause estrogen levels to rise. Historically, health care providers had concerns that these procedures could pose a risk for women with breast cancer, especially those with hormone receptor\u2013<\/span><\/span><\/span>positive tumors.<\/p>\n

Many women also take drugs to block hormones for up to 5 years after surgery for breast cancer. If they want to get pregnant during that time, a treatment interruption is required, explained Ann Partridge, M.D., who leads a clinic for young breast cancer survivors at Dana-Farber Cancer Institute and was not involved in the study. And pregnancy itself produces a bevy of hormones for 9 months that could potentially fuel the growth of breast cancer cells, she added.<\/p>\n

\u201cTwenty years ago, everybody was afraid that undergoing fertility preservation, or conceiving after breast cancer, was going to add fuel to the fire,\u201d said Dr. Partridge. Although those concerns have largely been put to rest, \u201cit\u2019s reassuring that there was no apparent harm in having a pregnancy or using assisted reproductive technology after breast cancer for these women,\u201d she said.<\/p>\n

Successful Births after Cancer Treatment<\/h2>\n

In the new study, researchers from Karolinska University in Sweden followed 425 women with breast cancer, aged 21 to 42 at diagnosis, who underwent fertility preservation between 1994 and 2017.<\/p>\n

For each of those women, the researchers identified two other women with breast cancer who did not undergo fertility preservation for comparison. Women were matched by age at diagnosis, year of diagnosis, and where they lived.<\/p>\n

Overall, 97 women in the fertility preservation group later gave birth to at least one child. Of those women, 20 used some form of assisted reproductive technology to conceive, and of those, 9 used embryos, eggs, or ovarian tissue banked before cancer treatment.<\/p>\n

Among the 850 women who didn\u2019t undergo fertility preservation, 74 eventually gave birth to at least one child. Three of those women used assisted reproductive technology to conceive.<\/p>\n

Although a greater percentage of women in the fertility preservation group (23% versus 9%) eventually had a successful pregnancy, the researchers couldn\u2019t directly compare the groups because it was unclear how many women in each group wanted to get pregnant, said Dr. Partridge. Women who had chosen fertility preservation were likely more motivated to have a baby, she explained.<\/p>\n

\u201cYou can\u2019t really conclude from this [study] that women who undergo fertility preservation are more likely to get pregnant than the women who don’t, independent of a desire to have a baby,\u201d she said.<\/p>\n

The women in the two groups also can\u2019t be directly compared in terms of survival because of inherent differences, explained Dr. Partridge. For example, those who underwent fertility preservation were likely healthier and at lower risk of cancer recurrence, a phenomenon called the healthy mother effect.<\/p>\n

Many Unanswered Questions<\/h2>\n

In the United States, large barriers remain for women with cancer who want to preserve their fertility, explained Dr. Levine. For instance, while fertility preservation is available to all women in Sweden under their national health system, many insurance plans in the United States don\u2019t cover it for young cancer patients.<\/p>\n

\u201cStates are starting to issue mandates related to health insurance coverage of fertility preservation,\u201d Dr. Levine said. \u201cNine states now have mandates: some of them are specific to cancer.\u201d However, this still leaves many women forced to pay out of pocket for fertility services, where bills can easily run over $15,000, she explained.<\/p>\n

\u201cI would argue that this [study] supports the idea that everybody should have the option to be covered by insurance to pursue fertility preservation,\u201d added Dr. Levine.<\/p>\n

\u201cIn some ways this is a gender equity issue, because, for men, banking sperm is much less expensive,\u201d said Dr. Tonorezos. Both the collection procedure and long-term storage are less costly for men, she explained.<\/p>\n

On the flip side, explained Dr. Partridge, more research is needed to determine which young women with breast cancer are most likely to need fertility preservation. Many younger women won\u2019t have their fertility impacted by cancer therapy, but currently it\u2019s not possible to predict that ahead of time, she said, leading many to undergo unnecessary fertility treatments.<\/p>\n

And more studies need to look at the success rate for pregnancy after fertility preservation for these women, added Dr. Levine. \u201cWe\u2019re limited, when we counsel patients, by not having that information,\u201d she said.<\/p>\n

\u201cThere\u2019s a lot that goes into these decisions around the time of diagnosis,\u201d agreed Dr. Tonorezos. “What opportunities are available to a woman medically, how she thinks about herself and her future childbearing potential\u2014those things are so important for helping people understand risk and benefit when making their decisions about fertility preservation.”<\/p>\n

Source<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

December 22, 2020, by NCI Staff Collecting eggs from a woman and creating fertilized embryos for storage may delay some parts of cancer treatment. Credit: iStock Common methods of preserving a woman\u2019s fertility before starting breast cancer treatment are safe for young women, according to a large study that tracked Swedish women for more than 2 decades. […]<\/p>\n","protected":false},"author":2,"featured_media":26630,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[5137],"tags":[],"class_list":["post-26629","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-world-news"],"_links":{"self":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/26629","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/comments?post=26629"}],"version-history":[{"count":1,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/26629\/revisions"}],"predecessor-version":[{"id":44030,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/26629\/revisions\/44030"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/media\/26630"}],"wp:attachment":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/media?parent=26629"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/categories?post=26629"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/tags?post=26629"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}