How does breast cancer affect the ability to get pregnant?
Via Cancer Consultant India
2.3 million women were diagnosed with breast cancer in 2020. There were 685 000 breast cancerrelated deaths globally. At the end of 2020, there were 7.8 million women who had been diagnosed with breast cancer in the past 5 years. This makes breast cancer one of the most prominent cancers in the world. National Cancer Registry Programme’s (NCRP) recent report estimates that the number of cancer cases in India will likely increase from 13.9 lakhs in 2020 to about 15.7 lakhs by the end of 2025. This is an increase of almost 20%. While breast cancer is rare in women aged 20-40, accounting for less than 5%, it is still the most common cancer in this age group. India is seeing an increase in the number of breast cancer patients in the 20-40 age group because of changing lifestyles and changing environments. Younger women diagnosed with breast cancer experience a unique set of challenges. First off, more often than not, breast cancer in that age range is detected at a later stage, when it is way more aggressive, making survival rates lower and recurrence rate higher. Secondly, in this age range, women having breast cancer can face multiple issues with pregnancy.
How breast cancer affects fertility?
A breast cancer diagnosis at a young age is scary enough without the constant worry if it will also prevent someone from having children. However, that is real doubt in the minds of many young breast cancer patients. As more and more women get diagnosed with breast cancer in their childbearing years, many want to know whether & if yes, how it will affect their fertility. As any cancer doctor of repute will agree, breast cancer itself does not directly affect the fertility of a woman, let’s get that out of the way first. Unless cancer directly affects the reproductive organs, it cannot cause fertility issues. However, the treatments of breast cancer like chemotherapy, radiation, hormonal therapy, etc, do adversely affect women’s fertility.
1.
Chemotherapy-The life-altering drug for premenopausal women
Chemotherapy is capable of causing infertility in premenopausal cancer patients. It can adversely affect the functioning of ovaries by reducing the number as well as the quality of eggs.
However, not all types of chemotherapy cause these issues. The likelihood of fertility issues with chemotherapy depends on multiple factors such as type of chemotherapy drug, the dose of the drug, age of the patient (30+ is more vulnerable), and previous fertility situation.
At-risk drugs: Alkylating agents like cyclophosphamide and taxanes (docetaxel and paclitaxel)
2. Radiation Therapy-Radiation and fertility in females
During breast cancer treatment through radiation therapy, the ovaries and uterus do not receive a significant amount of radiation to induce failure. Nevertheless, there can be scattering which has a low chance of causing infertility. However, if radiation is used with chemotherapy, then the chances of infertility increase.
3. Hormonal Therapy-Bane for premenopausal cancer patients
Hormone therapy is not used in all breast cancer patients. It is often used in patients whose breast cancer is estrogen receptorpositive or ER+. Here are some of the most commonly used drugs in hormonal therapy for premenopausal women diagnosed with breast cancer: ● ● ●
Tamoxifen Goserelin (Zoladex) Aromatase inhibitors (anastrozole, letrozole, and exemestane) alongside goserelin
With tamoxifen, most premenopausal women’s ovaries continue working. In fact, it may even stimulate ovulation, making the patient more fertile. However, getting pregnant while on the medication is not recommended by cancer doctors. There are some cases where continued use of the drug causes periods to become less regular, lighter, or stop completely. Generally, when the patient stops taking tamoxifen, the periods return if they haven’t gone into menopause naturally while on the drug. The return might take a few months. Goserelin, on the other hand, switches off estrogen production. Since it is often used with other drugs such as tamoxifen or aromatase inhibitors (otherwise safer drugs), it can cause infertility. Despite the many difficulties, women do conceive safely after breast cancer treatment today. One way to do it is through fertility preservation during the treatment.
Breast cancer fertility preservation There are risks associated with fertility after breast cancer treatment. However, there are also ways to go around that by preserving fertility before the treatments even begin. Freezing embryos/fertilized eggs created by IVF or in-vitro fertilization is the most widely used & effective way of fertility preservation. But unfortunately, it comes with some potential downsides. IVF takes 3-4 weeks, causing a delay in cancer treatment which might be dangerous for the patient depending on the staging and type of cancer. Also, IVF is extremely expensive. Some other ways are also being used. There is egg freezing which hasn’t been as successful as embryo freezing; then there’s ovarian suppression during treatment which keeps the ovaries somewhat protected during treatment; the brand new method under investigation is freezing entire strips of ovarian tissue.
Can you get pregnant if you have breast cancer – Conclusion Yes, getting pregnant is possible even if you’ve had breast cancer. However, your fertility post breast cancer diagnosis depends upon the type of treatment you’re receiving and the steps you’ve taken before your treatment. So, if you’ve been diagnosed with breast cancer and are of childbearing age, make sure you talk to your cancer doctor about your treatment plan and its effect on fertility. To ensure you get the best advice, consult an expert with experience and knowledge like Dr. Manish Singhal.