October is Breast Cancer Awareness Month, a time dedicated to raising awareness about breast cancer, promoting early detection, and supporting those affected by this disease. In the United States, over 11,000 women under the age of 40 are diagnosed with breast cancer every year (1).
While most conversations about breast cancer focus on diagnosis, treatment, and survivorship, it is crucial to address the impact breast cancer can have on a person's fertility and reproductive future.
Unfortunately, Oncologists (cancer specialists) do not always discuss the options for pregnancy after breast cancer treatment, leaving patients fearful that they will not able able to one day have a family of their own. We are here to chance that and educate you on how you or a loved one may have a beautiful fertile future despite the disappointment of a devastating diagnosis. In this blog post we will explore the intersection between breast cancer treatment and fertility, highlighting the vital role fertility clinics and resources play in supporting patients through their journey.
Understanding the Impact of Breast Cancer Treatment on Fertility
Standard breast cancer treatments can have a detrimental impact on reproductive health and may reduce a woman's ability to conceive in the future. Many women hesitate to undergo treatment due to concerns that the time required for treatment may further delay conception, potentially lowering fertility.
Cancer treatment options include:
Chemotherapy:
Many chemotherapy drugs used to treat breast cancer have a direct impact on fertility. One of the major consequences of using chemotherapy agents in what is know as "Chemotherapy Induced Amenorrhea" (2). This essentially means the absence of a menstrual period. It is important for you to speak with your doctor about the side effects of the medications they hope to incorporate into your treatment plan and if it will negatively impact your fertility.
Radiation Therapy:
The chances of the ovaries being exposed to radiation to the breast/axillary region during treatment is relatively low. However, the ovaries are still at risk of exposure and it is recommended that the pelvic region is carefully protected to minimize damaging effects.
Hormonal Therapy:
Hormonal treatments for breast cancer such as the medication, tamoxifen, may require patients to avoid pregnancy during the course of therapy. This delay can reduce fertility, particularly for those diagnosed at a later age.
Surgery:
Certain surgical procedures, particularly those involving the ovaries or uterus, carry the risk of organ damage, which can directly impact a woman's ability to conceive.
Understanding those potential impacts is crucial for patients diagnosed with breast cancer, especially those who have not started or completed their family building journey. This is where fertility clinics can play a pivotal role.
The Role of Fertility Clinics in Breast Cancer Care
Fertility clinics provide essential services and support to breast cancer patients who are concerned about their fertility. Here's how they can help:
Fertility Preservation Counseling:
Upon a breast cancer diagnosis, one of the first steps for patients should be consulting with a fertility specialist. These specialists provide detailed information on how various cancer treatments might impact fertility and will discuss options women have to preserve their fertility before beginning cancer treatment.
Egg and Embryo Freezing:
One of the most common fertility preservation methods for breast cancer patients is freezing eggs and/or embryos. This process involves stimulating the ovaries with hormones to produce multiple eggs before they are retrieved and frozen for future use. If the patient has a partner or chooses to use donor sperm, embryos can also be created and frozen to be used in the future.
Ovarian Tissue Freezing:
This is a newer technique where ovarian tissue is surgically removed and frozen before cancer treatment begins. After treatment, the tissue can be re-implanted in the hope that it will restore hormonal function and fertility. This option is often considered for younger patients or those unable to delay cancer treatment for egg retrieval. However this treatment is not commonly done at most clinics at this time.
Collaboration with Oncologists:
Fertility specialists work closely with oncologists to ensure a coordinated approach to treatment. This collaboration is vital to timing fertility preservation procedures around cancer treatment schedules to minimize any delay in cancer care.
Emotional Support:
A breast cancer diagnosis is overwhelming and the added stress of fertility concerns can be significant. Many fertility clinics offer counseling and support services to help patients navigate the emotional aspects of fertility preservation and future family planning.
Support for Male Partners:
While breast cancer predominantly affects women, men with partners undergoing treatment may also have fertility concerns. Fertility clinics can offer sperm banking for male partners who wish to preserve their fertility before their partners starts chemotherapy or radiation. It is also important to note, while very rare, breast cancer can also impact men. Less than 1% of all breast cancer cases impact men.
Resources to Help
Here at Grain Fertility, our goal is to empower you on your fertility journey and help connect you to organizations that working to educate breast cancer patients and survivors. Here are a few groups that help provide everything from grants, education, counseling, and other resources:
Founded by a cancer survivor whose fertility preservation was denied by her insurance company, their mission is to ensure every young woman newly diagnosed with cancer has the option to preserve fertility through direct financial support, education programs, and advocacy efforts.
RESOLVE works to ensure that all people challenged in their family building journey reach resolution through being empowered by knowledge, supported by community, united by advocacy, and inspired to act.
AFP works to increase information, resources and access to fertility preservation for cancer patients and the healthcare professionals who treat them.
The Livestrong Foundation helps thousands of fertility cancer patients gain access to life-changing services by alleviating the burden of costly fertility preservation. The Livestrong Fertility Discount Program works with over 150 clinics across the country that have committed to at least a 25% service discount for qualifying patients.
How Grain Fertility Can Help
One of the goals of Grain Fertility is to help fertility patients navigate the complexities that come with their journey and cancer patients often have more complex journeys that require additional coordination. Our team at Grain Fertility strongly advocates for a holistic approach to breast cancer treatment that includes fertility preservation as a standard part of care, ensuring all patients have access to the information and services they need.
The Grain Fertility application is specifically designed to help onco-fertility patients organize all of the information they collect during their cancer and fertility treatments so they and their care team have all of the information they need to make informed decisions. Our Patient Empowerment Coaches are here to support you, helping you navigate this frightening time. If you or a loved one is fighting a battle against breast cancer, our Patient Empowerment Coaches are here to discuss your options with you.
Fertility is a deeply personal and important aspect of life that shouldn't be overlooked, especially in the face of a breast cancer diagnosis. Fertility clinics play a crucial role in providing information, options, and support to those navigating this challenging path.
(1) Shah NM, Scott DM, Kandagatla P, et al. Young Women With Breast Cancer: Fertility Preservation Options and Management of Pregnancy-Associated Breast Cancer. Ann Surg Oncol. 2019;26(5):1214-1224. doi:10.1245/s10434-019-07156-7
(2) Ruddy KJ, Guo H, Barry W, et al. Chemotherapy-related amenorrhea after adjuvant paclitaxel-trastuzumab (APT trial). Breast Cancer Res Treat. June 2015;151(3):589-596.
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