Fertility an Issue for Breast Cancer Patients
Study Shows That Many Overestimate Their Risk of Early Menopause
Oct. 14, 2004 -- Young women facing breast cancer are concerned about preserving their ability to have children after treatment -- a concern often overlooked by doctors one of the largest studies ever to assess fertility concerns among patients 40 and under shows.
The findings highlight the need for better communication between younger breast cancer patients and their physicians, oncologist and researcher Ann Partridge, MD, tells WebMD.
"This should serve as a wake-up call to the medical community that fertility is an issue that needs to be addressed up front and should be included in any risk versus benefits analysis regarding treatment," she says.
Weighing Breast Cancer Treatment Options
Fertility was very much on the mind of breast cancer survivor Randi Rosenberg when she was deciding on a treatment course at age 32. Rosenberg had localized, stage II disease and she opted for a four-cycle chemotherapy regimen that included the drugs adriamycin and cyclophosphamide, in part, to reduce her infertility risk.
Several small studies indicate that the risk of premature menopause is around 10% to 15% in women under 40 treated with this regimen, compared with around 40% among women of the same age treated with an older, six-cycle regimen that includes the drugs cyclophosphamide, methotrexate, and fluorouracil.
"When I was diagnosed six years ago there really wasn't very much information available for women of my age with breast cancer," Rosenberg says. "It was very frustrating to try and navigate treatment options because younger women are not really included in clinical studies. I was lucky enough to have an oncologist that took my fertility concerns seriously."
Four months ago, at age 38, Rosenberg gave birth to her first child, a girl.
"My example is shared by many women who have been treated for breast cancer," she says. "Premature menopause is certainly a concern with breast cancer treatment, but the fabulous news for young women is that the risk is smaller than they might think."
11,000 Cases a Year
Women under 40 account for just 5% of breast cancers, but that translates into more than 11,000 cases among American women in this age group each year.
In an effort to gain a better understanding of young patients' attitudes about fertility, Partridge and colleagues from Dana-Farber Cancer Institute surveyed 657 members of the breast cancer patient advocacy group Young Survival Coalition. All the women who participated in the survey were premenopausal and 40 years old or younger at diagnosis.
According to the survey, 57% of the patients reported being somewhat or very concerned about infertility, regardless of their age or disease stage and almost a third said such concerns influenced their decisions about treatment. While 72% reported discussing their fertility concerns with their oncologist, 26% said they did not feel these concerns were adequately addressed. The findings are reported in the Oct. 15 issue of the Journal of Clinical Oncology.