Is There a Risk for Breast Cancer During Fertiliation of Art
, by NCI Staff
Collecting eggs from a woman and creating fertilized embryos for storage may delay some parts of cancer handling.
Credit: iStock
Common methods of preserving a woman's fertility earlier starting breast cancer treatment are safety for young women, co-ordinate to a big study that tracked Swedish women for more than 2 decades.
Most 6% of the women who chose to freeze their embryos, eggs, or ovarian tissue before undergoing handling for chest cancer died over the 23 years covered past the study. During the same menstruum, thirteen% of matched women who didn't undergo fertility preservation died, co-ordinate to the study results published on Nov 19 in JAMA Oncology.
For several reasons, such every bit age and chest cancer run a risk, straight comparisons betwixt these two groups are difficult to make, explained Emily Tonorezos, M.D., managing director of NCI's Office of Cancer Survivorship.
"But at the same time, this is very reassuring evidence about survival" afterwards fertility preservation and childbirth, Dr. Tonorezos said.
But 9 out of 425 women in the written report who underwent fertility preservation—nigh 2%—later used their banked embryos, eggs, or ovarian tissue.
But, given the big number of women diagnosed with breast cancer every year, "that's clinically meaningful, especially as there's no downside in terms of survival," said Jennifer Levine, M.D., who specializes in fertility later cancer treatment at Weill Cornell Medicine and New York-Presbyterian and was not involved in the current study.
"In my listen, that makes the case that these procedures should be considered a standard office of treatment for those who want information technology," she said.
Balance Concerns virtually Risk
Studies accept found that nearly half of immature women with breast cancer say they would like to have a kid after completing treatment. But some treatments for breast cancer, such as certain types of chemotherapy, tin can cause infertility.
Fertility preservation afterwards a chest cancer diagnosis tin exist complicated. While men can bank sperm quickly, collecting eggs from a woman and potentially creating fertilized embryos for storage (via cryopreservation) requires delaying some parts of cancer treatment for weeks or months.
In improver, methods used for preserving fertility at diagnosis—then later in assisted reproductive technology (including in vitro fertilization, or IVF) to conceive—involve the use of hormones that cause estrogen levels to rise. Historically, wellness care providers had concerns that these procedures could pose a risk for women with breast cancer, especially those with hormone receptor – positive tumors.
Many women likewise take drugs to block hormones for up to v years after surgery for breast cancer. If they want to get significant during that time, a treatment suspension is required, explained Ann Partridge, 1000.D., who leads a clinic for young chest cancer survivors at Dana-Farber Cancer Constitute and was not involved in the study. And pregnancy itself produces a bevy of hormones for 9 months that could potentially fuel the growth of breast cancer cells, she added.
"20 years ago, everybody was afraid that undergoing fertility preservation, or conceiving after breast cancer, was going to add fuel to the fire," said Dr. Partridge. Although those concerns accept largely been put to residuum, "information technology'south reassuring that there was no apparent damage in having a pregnancy or using assisted reproductive engineering science after breast cancer for these women," she said.
Successful Births later on Cancer Treatment
In the new study, researchers from Karolinska University in Sweden followed 425 women with chest cancer, aged 21 to 42 at diagnosis, who underwent fertility preservation between 1994 and 2017.
For each of those women, the researchers identified two other women with breast cancer who did not undergo fertility preservation for comparison. Women were matched by age at diagnosis, year of diagnosis, and where they lived.
Overall, 97 women in the fertility preservation group later gave nascence to at least one kid. Of those women, 20 used some grade of assisted reproductive technology to conceive, and of those, 9 used embryos, eggs, or ovarian tissue banked before cancer handling.
Among the 850 women who didn't undergo fertility preservation, 74 eventually gave birth to at least one child. Three of those women used assisted reproductive technology to conceive.
Although a greater percentage of women in the fertility preservation grouping (23% versus ix%) eventually had a successful pregnancy, the researchers couldn't directly compare the groups because it was unclear how many women in each group wanted to get pregnant, said Dr. Partridge. Women who had called fertility preservation were likely more motivated to accept a baby, she explained.
"You can't really conclude from this [study] that women who undergo fertility preservation are more than likely to get pregnant than the women who don't, independent of a want to have a baby," she said.
The women in the 2 groups also tin't be directly compared in terms of survival because of inherent differences, explained Dr. Partridge. For case, those who underwent fertility preservation were likely healthier and at lower risk of cancer recurrence, a miracle chosen the salubrious female parent issue.
Many Unanswered Questions
In the Us, big barriers remain for women with cancer who desire to preserve their fertility, explained Dr. Levine. For example, while fertility preservation is available to all women in Sweden under their national health system, many insurance plans in the United States don't comprehend it for young cancer patients.
"States are starting to issue mandates related to health insurance coverage of fertility preservation," Dr. Levine said. "Nine states at present have mandates: some of them are specific to cancer." Even so, this still leaves many women forced to pay out of pocket for fertility services, where bills tin can easily run over $15,000, she explained.
"I would debate that this [study] supports the idea that everybody should accept the option to exist covered by insurance to pursue fertility preservation," added Dr. Levine.
"In some ways this is a gender disinterestedness issue, because, for men, banking sperm is much less expensive," said Dr. Tonorezos. Both the drove procedure and long-term storage are less plush for men, she explained.
On the flip side, explained Dr. Partridge, more research is needed to determine which immature women with chest cancer are most probable to need fertility preservation. Many younger women won't have their fertility impacted by cancer therapy, but currently it's non possible to predict that ahead of fourth dimension, she said, leading many to undergo unnecessary fertility treatments.
And more studies need to look at the success charge per unit for pregnancy after fertility preservation for these women, added Dr. Levine. "We're express, when we counsel patients, past not having that data," she said.
"There'due south a lot that goes into these decisions around the time of diagnosis," agreed Dr. Tonorezos. "What opportunities are available to a woman medically, how she thinks about herself and her futurity childbearing potential—those things are so important for helping people understand risk and benefit when making their decisions well-nigh fertility preservation."
cairndufftruiessinter.blogspot.com
Source: https://www.cancer.gov/news-events/cancer-currents-blog/2020/breast-cancer-fertility-preservation-safe