How Breast Cancer Can Affect Fertility
Breast cancer is one of the most common cancers among women in South Africa, and the incidence of breast cancer among South African women is increasing. October is locally observed as Breast Cancer Awareness Month, dedicated to raise awareness of this debilitating disease and the fact that early detection can save lives.
Breast cancer can also affect fertility in some women, and in this article, our Medfem team add our voices to breast cancer awareness efforts to ensure better understanding of the possible impact of breast cancer on a woman’s fertility and the fertility preservation options that are available.
Breast cancer is the most common cancer affecting women in South Africa across all races and class structures, with a lifetime risk of 1 in 27, according to the 2019 National Cancer Registry (NCR). It is the most prevalent cancer amongst white and Asian women and the second most common cancer among black and coloured women.
Many breast cancer awareness efforts focus on raising awareness of the importance of early detection of the condition, which can result in more effective treatment and a positive prognosis, which leads to a reduction in pain and suffering, and a significant decrease in the loss of life. In fact, when breast cancer is detected at the early stages, about 90% of patients survive for many years after diagnosis. The keys to early detection are regular breast self-examination and regular mammograms.
Who is at risk of getting breast cancer?
All women are at risk of breast cancer, especially women with a family history of breast cancer. The risk for breast cancer increases as women grow older, but many women under the age of 40 are also diagnosed with breast cancer.
A cancer diagnosis is devastating and turns a person’s world upside-down. Winning the breast cancer battle only to find you are unable to conceive or carry a child opens the door to an entirely new difficult challenge. But fortunately, there are options for those facing breast cancer to avoid this pain.
Breast cancer and infertility
A breast cancer diagnosis does not mean you will definitely become infertile. The degree to which breast cancer affects fertility is dependent upon a variety of factors such as the type of breast cancer, the progression of the cancer, whether you will enter early menopause, and the type of cancer treatment prescribed.
Cancer treatment can harm fertility potential. When taking into consideration how cancer treatment will affect fertility, there are a number of different factors. Cancer type and age play a large role – some cancers are more aggressive than others and may be hormone-sensitive.
Women are born with as many eggs as they will have in their lifetimes. The resilience and health of eggs for a woman who is 39 years of age will not be the same when compared to a woman five years younger. The treatment prescribed, be it surgery, chemotherapy or radiation, will determine how much damage the ovaries and reproductive organs will sustain. Delving further, the dose, type, duration, location and scope used for these methods will also affect whether or not treatment will impact fertility.
Taking into account all of these factors can make it very difficult to predict whether a women’s eggs or reproductive organs will maintain function after cancer treatment. A discussion between your oncologist and your reproductive specialist can better estimate what your fertility potential will be after cancer treatment. With both teams working on your behalf, the probability for future success is increased.
It is also good to know that fertility drugs are not linked with cancer. Infertility drugs and pregnancy can increase a woman’s hormone levels. If a hormone-sensitive tumour is present in the breast, there is a possibility that breast cancer growth will accelerate. But although increases in hormones can accelerate certain types of breast cancer, studies have confirmed that there is no link between breast cancer risk and fertility treatments.
Reducing the impact of breast cancer on fertility
There are various techniques oncologists can use that can minimise the damage done to reproductive potential. For example, ovarian shielding can protect ovaries during radiation, while ovarian suppression methods temporarily shut down the ovaries. After treatment, some women may retain their fertility potential.
For others, menopause may arrive earlier in life, or even immediately after treatment. For those women, it is crucial to understand their future family building options.
Fertility can be preserved
If you are planning on having a family after breast cancer treatment, there are several different options to preserve or protect your fertility. These include egg freezing, embryo freezing and even ovarian tissue freezing.
The goal is to freeze somewhere around 10 to 15 eggs before cancer treatment commences to optimise the chances of achieving success later in fertilising the eggs and implanting these back into the patient’s uterus, to hopefully achieve a pregnancy.
Generally, egg freezing is a process completed over one to two months. However, for cancer patients, the evaluation and treatment are done together to quickly freeze eggs before moving on to cancer treatment immediately.
Patients first complete blood tests and ultrasounds to determine their candidacy for egg freezing. Next, medicines are taken for two weeks to prepare the eggs before an egg retrieval procedure is done.
While taking the medicines, the growth of the eggs is monitored with ultrasound and blood tests to check when they will be ready. During the quick egg retrieval process, patients are placed under light sedation, and may feel a bit of cramping and bloating afterwards.
Patients with hormone-sensitive breast cancer or breast cancer that has progressed may not be eligible for this form of fertility preservation.
Where patients already have a partner, the best option for future success is to freeze fertilised eggs, or embryos.
The little eggs are extremely delicate and fragile and not all frozen eggs will survive the thawing process. To improve the chances of a successful pregnancy later, the patient will undergo an egg retrieval as described above, but after the egg retrieval, the eggs will be fertilised with the partner’s sperm.
The resulting embryos are then frozen and can be used in the future for fertility treatment. If carrying a baby in the future is not a possibility, a gestational carrier or surrogate is also an option.
Ovarian tissue freezing
While ovarian tissue freezing is still an experimental procedure and not widely available, it is an option for those looking to preserve fertility in the face of cancer treatment.
Patients undergo a surgical procedure where part or all of an ovary is removed. The ovarian tissue containing immature eggs and hormone-producing cells is then cut into strips and cryopreserved. After a patient is cancer-free, the frozen ovarian tissue is thawed and transplanted back to the patient’s uterus. Even if this isn’t for years, the frozen ovarian tissue will remain the same age as when it was cryopreserved.
Who to contact for fertility preservation
Medfem Fertility Clinic’s team are committed and understanding team of medical professionals, who have the experience, knowledge and desire to provide you with the best fertility preservation advice and highest chance of a successful outcome at the end of your future fertility treatment.
Medfem Fertility Clinic’s team has assisted thousands of people facing cancer treatment to preserve their fertility, giving them a chance to still experience the joy of having their own babies after the cancer treatment is successfully completed.
If you would like to meet one of our fertility specialists, simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244.
Our Fertility Specialists can also meet with You During a Virtual Consultation Via Zoom or Skype. Click here to book a virtual consultation now.