Preserving Fertility inYoung Women DiagnosedWith Breast Cancer

In the US, breast cancer is the most common invasive cancer in women, with more than 200,000 diagnosed with the disease each year.[1] Approximately 25% of these women will be diagnosed before they experience menopause.[2] Because childbearing often is delayed until later in life, many premenopausal young women with breast cancer may not have started to have children or completed their families.

Improved public awareness, routine diagnostic testing with mammography, and medical advances in treatment have greatly increased the chances of long-term survival following a diagnosis of breast cancer. The life-saving treatment of breast cancer often profoundly affects fertility, leaving many women unable to fulfill childbearing goals.[3,4] For all women, breast cancer is a crisis; for young women desiring children, the combined threat to life and fertility is likely catastrophic.

Infertility following treatment is related to gonadotoxic chemotherapeutic agents and/or the length of time required to complete treatment.[5] Age at diagnosis is a major factor, as fertility naturally declines with age; women in their later childbearing years are at an increased risk for ovarian failure and permanent infertility.[3] Ovarian function following treatment is also related to ovarian function at the time treatment began and the specific chemotherapeutic agents prescribed (eg, see Table 1).[6,7]

The ideal time for fertility preservation is prior to treatment with chemotherapeutic or hormonal agents, meaning very soon after diagnosis. Yet many women diagnosed with breast cancer report not receiving information about the effect of treatment on fertility or on fertility preservation.[8–12] Most women diagnosed with breast cancer want comprehensive information about fertility preservation and want to retain the ability to have children.[8] The following case studies illustrate fertility-related concerns and issues facing young women with breast cancer.

Case Study 1
“Britney S.” is a 28-year-old single woman recently diagnosed with stage IIa breast cancer. Several weeks ago while showering, she found a lump in her left breast and went to her gynecologic provider for evaluation. A mammogram indicated a suspicious lesion in the left upper outer quadrant of her breast; a breast biopsy confirmed the lesion was cancerous. She is attending her initial appointment at a comprehensive breast health clinic to discuss treatment options with oncology healthcare providers.

Her health history indicates no prior significant health problems, and she has had no prior pregnancies. She has a positive family history of maternal breast cancer. Her social history reveals that she has recently accepted a new job as a financial analyst; her boyfriend has accompanied her to this initial visit and appears supportive. Visibly upset over the discussion of treatment options and long-term side effects, she is crying and states she has always planned to “get married at some point” and have a family.

Case Study 2
“Rebecca J.” is a 36-year-old woman who has transferred to her current healthcare provider from a clinic in another state. Diagnosed with stage II infiltrating ductal carcinoma of the right breast at 31 years of age, her records indicate that she has had breast-conserving surgery followed with 5 weeks of radiation therapy. She received four cycles of anthracycline-based combination chemotherapy every 3 weeks. She is hormone receptor–positive and is currently taking tamoxifen. She says that at the time of her diagnosis, she and her husband had just decided they were ready for children. She states that now that her treatment will soon be complete, she would like information about cancer and pregnancy, because she and her husband would like to start building a family as soon as her healthcare providers feel it is safe to do so. She has never been pregnant.

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