December 5, 2003
Fertility worries common in young breast cancer survivors
Eric Winer, MD, and Ann Partridge, MD, MPH
A survey of young breast cancer survivors found that more than half likely overestimated their risk for developing treatment related infertility, according to Dana-Farber researchers.
The study, described in an oral presentation today at the San Antonio Breast Cancer Symposium, is the largest to date that addresses fertility and menopausal concerns among young women with breast cancer.
The results serve as a wakeup call for health care providers, said Ann H. Partridge, MD, MPH, because "we don't have a great system for educating these women and showing them data ญญ- even if incomplete - about these questions and advising them on what they can consider to attempt to preserve fertility."
According to the result of the Web-based survey, 72 percent of the women said they had discussed fertility issues with their doctor and 17 percent had talked with a fertility specialist. Still, one-quarter of the women felt their unease about fertility was not adequately addressed.
As to whether a woman will retain her fertility, Partridge said the effects of older treatments are fairly well known, but there is less information on newer chemotherapy agents and ways of administering the chemotherapy. When asked to estimate their odds, more than half of women under 30 thought they had a 40 percent or greater chance of becoming infertile, when, in fact, research has revealed that very few women in this age group go through menopause with standard treatment, said Partridge. Some studies, she added, even showed a zero percent incidence in these patients. "Their risk perceptions are likely grossly exaggerated; there is room for education here."
Partridge, of the Breast Oncology Center at Dana-Farber, headed the study; Eric Winer, MD, the Center's director, is the senior author. The survey's 657 respondents were members of the Young Survival Coalition (YSC), an Internet-based advocacy group for young women with breast cancer. The mean age of the women who completed the survey was 35.8 years, and their mean age at diagnosis was about 33 years.
Most of the women were within two years from diagnosis when they were surveyed. More than half, or 57 percent, said that they were concerned about becoming infertile as a result of treatment, and 29 percent reported that fertility concerns influenced their decisions about treatment.
Anecdotally, doctors often assume that infertility concerns might be more pressing in younger women and those with less-advanced cancers, "because women with high-risk disease might be thinking more about the cancer risks than about having future children," said Partridge. "We actually found that concerns about fertility following treatment were most common among women who had a desire for future children - regardless of their age or the stage of their cancer."
Breast cancer in young women, defined here as age 40 and under, is not common, but accounts for over 11,000 cases a year in the U.S. alone. Chemotherapy administered following surgery can cause early menopause and infertility. In addition, concern has been raised about whether a pregnancy following breast cancer treatment raises the odds of a cancer recurrence. Partridge said that data on the latter are "reassuring," but that the question is not yet answered.
Dana-Farber Cancer Institute is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive cancer center by the National Cancer Institute.
