Most patients diagnosed with breast cancer are not provided with information on how their treatment may affect their capacity to have children.
The combination of new treatments in addition to improved early diagnostic techniques has greatly reduced the mortality rate for breast cancer. That means that many women diagnosed with breast cancer early on, or whose prognosis after treatment is favorable, and who are fertile, consider becoming mothers. So, specialists point out that approaching the issue of fertility preservation from the moment the diagnosis is made is fundamental.
“The reality is that nowadays most patients diagnosed with breast cancer are not informed about how cancer treatments can affect their ability to produce children. That is why it is so important to explain to any young breast cancer patient the options for preserving their fertility prior to beginning treatment”, explains Dr. Gloria Ortega, specialist with the Breast Cancer Unit at MD Anderson Cancer Center Madrid.
Breast cancer patients are often overwhelmed with questions about how cancer can affect their maternity and, in particular, about the impact cancer treatments may have on fertility. “The effects of chemotherapy on a woman’s fertility depend on the kind of treatment she is given, her age, her health prior to having cancer and on her body’s response to treatment. But, in any case, the drugs she is administered will directly affect the function of her ovaries. Thus, the older the woman is, the more complicated pregnancy is after treatment. Furthermore, the effectiveness of treatments used to preserve fertility are compromised the older a patient is”, explains Dr. Ortega.
Another cause for concern among patients is whether or not they will be able take a pregnancy to full term without complications. As the doctor points out, “there is no evidence that pregnancy affects the prognosis of women who have undergone treatment for breast cancer. Neither is there any reason to think that a pregnancy in such women will be affected in any way, although some precautions must be taken, like postponing plans for pregnancy until at least two years after treatment and monitor the patient’s breasts throughout the pregnancy by means of physical exams and image tests”.
The question of breastfeeding is another concern for breast cancer survivors considering having children. The body’s capacity to produce breast milk is a complex process depending on a variety of factors that are both mechanical and hormonal. From the mechanical point of view, both radiotherapy and surgery, as local treatments, may alter the structure of the breast and therefore, make the possibility of breastfeeding difficult.
“Only in cases in which a bilateral mastectomy (removal of both breasts) is done is the possibility of breastfeeding eliminated, as the breast tissue is completely removed. In those cases where conservative surgery is done, in which only part of the breast tissue is removed, the capacity to respond to stimulus can be preserved and therefore, the capacity to produce milk also. If in addition neither the nipple-areolar complex nor the retroareolar mammary ducts have been removed, it would also be possible, mechanically, to breastfeed a baby”, concludes Dr. Ortega.