Breast cancer in young women and its impact on reproductive function

Abstract

BACKGROUNDBreast cancer is the most common cancer in women in developed countries, and 12% of breast cancer occurs in women 20–34 years. Survival from breast cancer has significantly improved, and the potential late effects of treatment and the impact on quality of life have become increasingly important. Young women constitute a minority of breast cancer patients, but commonly have distinct concerns and issues compared with older women, including queries regarding fertility, contraception and pregnancy. Further, they are more likely than older women to have questions regarding potential side effects of therapy and risk of relapse or a new primary. In addition, many will have symptoms associated with treatment and they present a management challenge. Reproductive medicine specialists and gynaecologists commonly see these women either shortly after initial diagnosis or following adjuvant therapy and should be aware of current management of breast cancer, the options for women at increased genetic risk, the prognosis of patients with early stage breast cancer and how adjuvant systemic treatments may impact reproductive function.METHODSNo systematic literature search was done. The review focuses on the current management of breast cancer in young women and the impact of treatment on reproductive function and subsequent management. With reference to key studies and meta-analyses, we highlight controversies and current unanswered questions regarding patient management.RESULTSChemotherapy for breast cancer is likely to negatively impact on reproductive function. A number of interventions are available which may increase the likelihood of future successful pregnancy, but the relative safety of these interventions is not well established. For those who do conceive following breast cancer, there is no good evidence that pregnancy is detrimental to survival. We review current treatment; effects on reproductive function; preservation of fertility; contraception; pregnancy; breastfeeding and management of menopausal symptoms following breast cancer.CONCLUSIONThis paper provides an update on the management of breast cancer in young women and is targeted at reproductive medicine specialists and gynaecologists.

Mindfulness Based Breast Cancer Management: Review Study

“…Social workers and psychologists are skilled in the assessment of psychological needs and selection of coping strategies [27]. The management of symptoms in women with breast cancer is challenging and is frequently made even more so by the potentially psychological related complications [28]. Although some women with breast cancer can live for long periods.…”

Oncofertility in Canada: cryopreservation and alternative options for future parenthood

“…Although the benefits of using embryos for cryopreservation include improved pregnancy rates and widespread availability in fertility centres 8 , multiple drawbacks still have to be considered.…”

“…There is no need for a partner or donor sperm. The method also avoids ovarian stimulation and the passage of protracted amounts of time before chemotherapy can begin 8 . Additional advantages include the possibility that primordial follicles within the ovarian tissue are more resistant to cryopreservation than are oocytes themselves 19 .…”

“…Donation has the added advantage of preventing the passage of genetic material that may be associated with the patient's cancer (for example, BRCA genes) 8 . Despite pregnancy and live birth rates being comparable or better in donor cycles than in cycles using autologous oocytes (donor oocytes often come from young, healthy women) 95 , accessibility is a limitation 96 .…”

“…Canada places restrictions on financial compensation to oocyte donors (only reimbursement of expenses incurred by the oocyte donor are allowed) and also prohibits oocyte sharing programs in which the donor receives financial incentives 97 . Additional challenges include the heavy burden of health care expenses for both the patient and the oocyte donor, the difficulties associated with seeking out a suitable oocyte donor, and the potential fears and psychosocial consequences of having a genetically unrelated child 8,98 . Sperm donation may be a similar option for men experiencing failed cryopreservation of their own spermatozoa.…”