Motherhood after treatment for breast cancer

Abstract

In recent years, the number of women who delay their pregnancies until later in life has increased. At the same time, the number of premenopausal women with breast cancer is also on the increase. Consequently, the percentage of breast cancer patients at reproductive age with fertility problems resulting from chemotherapy is growing. Pregnancy after treatment for breast cancer has no adverse effects on the prognosis of patients with early-stage disease. Some studies show a decreased risk of distant dissemination. Women wishing to have children after breast cancer treatment should be reassured that there is not evidence that pregnancy will affect their survival. Usually it is recommended that pregnancy be delayed until 2 to 3 years after the completion of the treatment. The adjuvant chemotherapy used in the treatment commonly affects fertility and causes premature ovarian failure. The risk of amenorrhea and infertility after chemotherapy is related to the patient’s age, the specific chemotherapeutic agents used, and the total dose administered. Recent advances in the field of fertility preservation may help many of breast cancer survivors to have children in the future. The most established option is embryo cryopreservation. Another technique includes oocyte cryopreservation. However, these two approaches require ovarian stimulation. For ovarian stimulation in women with breast cancer, protocols using tamoxifen or aromatase inhibitors have been reported. Ovarian tissue cryopreservation is another option. The use of gonadotropin-releasing hormone (GnRH) agonists to protect the ovarian function is controversial. Oncologists should discuss possible fertility options with the patients undergoing therapy.