What there is to know about having a baby when you have breast cancer.
Breast cancer can be scary enough without wondering if it will also prevent
you from having children. More and more American women are diagnosed with
breast cancer in their childbearing years, and many want to know how the
disease will affect their fertility.
While there's no one-size-fits-all answer to this complex question, WebMD
asked the experts for answers to some tough questions including: What are risks
posed by cancer treatment, methods of preserving fertility, and ways cancer
might affect future offspring.
By Fran SmithWhy even smart doctors miss breast cancer - and how to make sure you're
getting the best care.
No matter what you know about other diseases, breast cancer is probably the
one that scares you most. It is frightening, striking nearly 182,000
women this year and plunging them into a world of complicated, arduous
treatment. So it's heartening to know that more women are being diagnosed
early, when the odds of beating the cancer are as high as 98 percent.
Prevention and treatment...
More than 11,000 women under 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
Not all breast cancer treatments affect fertility.
"If a patient needs only surgery and radiation and no chemotherapy, the
treatment will have no impact on future fertility," Robert Barbierri, MD,
chief of obstetrics and gynecology at Brigham and Women's Hospital in Boston,
tells WebMD. The same, however, cannot be said for chemotherapy.
Breast cancer patients treated with chemotherapy run the risk of developing
premature ovarian failure or very early menopause. Almost four out of five
women treated with cyclophosphamide -- an often-prescribed chemotherapy drug
for treating breast cancer -- develop ovarian failure, according to Kutluk
Oktay, MD, assistant professor of reproductive medicine and obstetrics and
gynecology at Cornell's Center for Reproductive Medicine and Infertility.
FertileHope, a nonprofit organization dedicated to disseminating education on
infertility associated with breast cancer treatment, places the risk at 40% to
Type and Stage of Cancer
How advanced a cancer is upon detection, as well as what type it is, dictate
whether chemotherapy will be required, thereby affecting the risk of side
effects to the ovaries.
The more advanced the cancer upon detection, the greater likelihood that
chemotherapy, which affects the whole body, will be used to treat it. For
instance, invasive breast cancer typically requires systemic chemotherapy,
whereas a small tumor with small nodes that is localized and contains a minimal
threat of spreading may not.
The type of tumor also impacts a patient's treatment options. Some breast
cancers can be treated with the use of hormone-containing drugs. But a small
percentage of breast cancer tumors are "hormonally insensitive,"
explains Susan Domcheck, MD, assistant professor of medicine at the University
of Pennsylvania. What does this mean? "You can't use hormones to treat
them. You're left with chemotherapy as your only option."
Age of Patient
Age plays a big role in patients' future fertility. "The age of the
woman at the start of systemic chemotherapy is the biggest predictor of
infertility," Barbierri tells WebMD. But why?
"If you're 30, your fertility is already declining. Add to that
chemotherapy, and you tack on a few more years. We know that chemotherapy
induces menopause, particularly with women over 40," Domcheck says.