At a time when more young women are surviving breast cancer and delaying childbirth, it is important to take their needs and wishes about their future fertility into consideration when deciding on treatment.
Dr. Anne Armstrong, from the Department of Medical Oncology, the Christie NHS Foundation Trust, Manchester, UK, say that, although survival remains the most important priority for most women, many are also concerned about being able to make choices concerning their fertility and potential to become pregnant.
The use of chemotherapy and hormonal treatments in young women can have significant implications for their fertility. Such treatments can stop the ovaries producing eggs, sometimes temporarily but also permanently, thus leading to an early menopause. Options to preserve fertility include freezing eggs or embryos, and also freezing ovarian tissue for transplant at a later date, although this is a new, and to date, little-used technique.
Because of rising breast cancer survival rates and the trend to delay pregnancy until later in life, childless women increasingly experience fertility dilemmas. Dr. Armstrong and her team decided to investigate women's responses to being told that treatments affected their fertility, as well as their attitudes to fertility options.
Twenty-four women who were under 40 at diagnosis with early-stage breast cancer participated in three focus groups. Seven of them had attended specialist fertility services. The researchers found that fertility was a significant issue for many of them. "Many of them had concerns about the implications on breast cancer survival of fertility preservation, changes to treatment to improve fertility, and also pregnancy after breast cancer," says Dr. Armstrong. "They were also concerned that egg harvesting might carry risks to their survival. We found that many of them were getting conflicting advice from health professionals, and this led to increased anxiety and confusion."
The small number of women who had attended specialist fertility services were better informed of their options and of the potential risks of fertility-preserving treatment, and this appeared to be a positive experience which helped them to cope better with the issues, the researchers say. They are now planning to undertake a larger study of both patients and health professionals based on a questionnaire to explore the issues more fully.
"We hope that this will enable us to understand patients' needs better and enable us to develop services which will meet those needs effectively," says Dr. Armstrong. "At a time when breast cancer treatments are improving and allowing more women to live normal lives, it is only right that we should also be helping them, where possible, to take control of their fertility, and informing them about the opportunities to have children should they so desire."