Conversations about fertility in young breast cancer patients

Dr Ronwyn van Eeden clarifies the conversations oncologists should be having with young breast cancer patients about fertility.

Being diagnosed with breast cancer is daunting. Receiving that diagnosis when you’re very young is an absolute shock. In the midst of processing the news, having to answer questions from your oncologist like: How many children do you have? Do you plan to have more? Are you sure you have completed your family? Are you absolutely sure that you don’t want any kids? can be completely overwhelming. 

Times have changed. It’s not the 1950s where having kids by 25 is the norm. Although your late twenties or early thirties seems a reasonable time to already have answers to those questions, currently, many at this age are career-focused, completing studies, planning to travel or fulfilling other aspirations. A decision whether or not to embark on fertility preservation can leave you reeling between biopsies and scans and chemotherapy looming. 

Correct conversations are needed

There are many considerations from the oncology side when faced with a young breast cancer patient of childbearing age. It’s important that the correct conversations are had at oncology appointments that addresses all the concerns and needs of a newly diagnosed patient.

Firstly, oncofertility should always be discussed if you are of childbearing age, whether you haven’t yet started or have already completed your family or are even unsure or have ambivalent feelings about it, and irrespective of the type or stage of your cancer.  

As oncologists, basic questions about oncofertility can be answered. 

A significant proportion of young patients are concerned about the possible impact of anti-cancer treatments on their fertility and future chances and risks of conception. 

Other points of discussion, importantly, is safety around the time frames and periods from initial diagnosis to delaying the start of treatment to allow time to seek advice on different oncofertility options. It’s important to reflect on if this will or will not impact the outcome or the treatment or increase the risk of the cancer growing or spreading. 

There is always time

The short answer is that there is always time to fully investigate and gather all the information about oncofertility treatment first and even make sure that adequate plans and preservation techniques are implemented before commencing therapy.

The different types and full range of options are usually best discussed with an oncofertility specialist. It’s the responsibility of the oncologist to refer you as early as possible. 

Other conversations should be around psychological support and referral to or depending on your religious or cultural belief someone who can assist you in the decision to pursue intervention.  

Gonadotropin-releasing hormone analogue

Sometimes your oncologist can also recommend using a gonadotropin-releasing hormone analogue (GNRH) during chemotherapy which suppresses your ovarian function and adds a degree of ovarian protection from damage caused by chemotherapy. 

The benefit of this is usually a bit more in women with hormone receptor negative breast cancer. The follow-on discussion about this is the side effects that can be caused by this, which include hot flushes, fatigue and some other ‘menopausy’ symptoms. More so also the cost involved around it and getting medical aids to fund it. 

Later conversations

Later conversations around side effects should include hormonal balances or functional changes to reproductive organs and impaired sexual function in both sexes, depending on the type of anti-cancer treatment given.

After adequate treatment and follow-up, pregnancy in cancer survivors should never be discouraged. The length of time to wait to fall pregnant after completing your cancer treatment isn’t clear. Some guidelines suggest waiting two years to detect early cancer recurrences, but the age of the patient and the type of cancer is taken into consideration. It’s always important to check with your oncologist when it’s a safe time to start thinking about this. 

Our job, as oncologists, is to also create awareness, be activists for patients, try to actively motivate medical aids to fund and pay for this as a benefit, as it can be expensive and also cause a financial burden for patients. Between patient and doctors, also to create opportunities for research and local data so that we can know outcomes for our own population groups. 

Dr Ronwyn van Eeden is a medical oncologist in private practice in Rosebank, Gauteng. She is also an honorary consultant in oncology at the Chris Hani Baragwanath Academic Hospital.

MEET THE EXPERT – Dr Ronwyn van Eeden

Dr Ronwyn van Eeden is a medical oncologist in private practice in Rosebank, Gauteng. She is also an honorary consultant in oncology at the Chris Hani Baragwanath Academic Hospital.

Header image by Adocbe Stock