September 3, 2012 6:18:15 PM WATime
Thanks for your queries Jo - this is a very important issue for many younger women diagnosed with breast cancer and wanting to think about having children, or who develop bc during pregnancy.
There are several different aspects to your queries, so I have divided them into separate headings. My comments are generic to try to cover these aspects for others too ..
BREAST CANCER AND FERTILITY:
Treatments for breast cancer may affect a woman’s fertility. Specifically, treatments such as chemotherapy and hormone therapy may have a significant impact. Many factors may influence this.
Chemotherapy has a potential effect on the ovaries similar to the aging process. A common ‘rule of thumb’ is a course of chemotherapy may age the ovaries by ~10 years, possibly causing decreased fertility and an earlier menopause. However this is not an absolute certainty, and each woman may have a differing outcome.
Chemotherapy often causes periods to ‘stop’ during treatment - known as temporary menopause (although this is less likely to occur for women <30yrs). Periods may resume after one year or so, or may result in permanent menopause. Effects from chemotherapy on ovaries depend upon:
– age a woman is when she has treatment (the closer to 40yrs of age, the higher chance of permanent menopause)
– type of chemotherapy drugs given (some have greater impact on fertility)
– previous ovarian function
Hormone Therapy for hormone-positive cancer in pre-menopausal women often involves Tamoxifen and/or ovarian suppression.
-Tablet treatment with Tamoxifen does not cause infertility – in fact women are advised to take precaution to not fall pregnant for the duration of treatment. However, as Tamoxifen is usually given over 5 years, natural aging occurs and fertility may lower.
- Ovarian suppression may be temporary or permanent. Temporary suppression with injections such as Goserelin (Zoladex) are unlikely to affect fertility when ceased (in fact are now trialled to protect ovaries during chemotherapy), however permanent ovarian suppression with surgery to remove ovaries (oophorectomy) or radiation (ablation) will induce permanent menopause and infertility.
Measuring fertility after treatment (where permanent menopause has not occurred) is difficult, and may not be known until a pregnancy occurs. Many women have successfully conceived after chemotherapy. Extensive research has not shown a detrimental effect to the outcome of pregnancies >6 months after treatment.
BREAST CANCER AND PREGNANCY:
For many years falling pregnant after a breast cancer diagnosis was thought to increase the risk of cancer recurring, and was usually discouraged. For younger women who have not had children or completed their families, this was another devastating blow in trying to regain a sense of normality in their lives. With improved research, treatments and outcomes, this is no longer the case. There is no evidence that pregnancy will increase the risk of breast cancer returning.
The main aspects when considering a pregnancy after bc treatment are:
– desire to have children. This will depend on individual circumstances such as: completion of family, relationship situation, financial considerations, etc
– ability to have children. If fertility is compromised, seeking advice from fertility experts is recommended to discuss options (e.g. IVF, egg donation, etc)
– completion of recommended treatments. If treatment for hormone-positive cancer includes hormone therapy over 5 years, time delay in planning pregnancy may have major impact. Ceasing or declining treatments may increase risk of breast cancer returning. Careful consideration of influence to risk is recommended
– prognosis. Recent studies suggest women with low-risk early stage breast cancer wait only 3-6 months after treatment completed. If higher-risk cancer, recommendation to wait 2 - 3 years to assess progress. Poor prognostic cancers such as metastatic breast cancer are advised to avoid pregnancy due to compromise in treatments and outcomes
If diagnosed with breast cancer during pregnancy, the stage of pregnancy is very important with regard to treatments. The first trimester of pregnancy is the critical phase of development, hence few treatments are considered safe for the foetus. The second and third trimesters are generally safe for most treatments except radiation – which is preferred to be given after delivery.
Each individual case needs to be carefully assessed and managed for the welfare of the woman and the pregnancy.
SCREENING TESTS AND PREGNANCY:
** If planning a pregnancy, it is strongly recommended to have routine imaging prior to conceiving (e.g. annual mammogram, etc) to avoid needing imaging during pregnancy.
- Mammogram during pregnancy is considered safe to the foetus, however is still treated with caution and an abdominal shield may be used. Breast tissue density increases during pregnancy – therefore mammograms are more difficult to read and less accurate.
- Ultrasound of the breast is safe during pregnancy, hence any lumps or changes will be investigated with ultrasound first.
- MRI scans are not recommended through pregnancy unless necessary. Although no known harmful effects to foetus, safety is not proven – particularly with use of the contrast agent Gadolinium.
If already pregnant, advising your doctor and radiology staff is recommended and appropriate imaging may still be carried out as needed.
BREAST-FEEDING DURING PREGNANCY:
Breast feeding has long been established as beneficial to the mother and baby.
Breast feeding after breast cancer has no detrimental effects on prognosis, and is not harmful to the baby if not undergoing treatments for breast cancer.
** After treatment with radiation therapy, feeding from the treated breast is often not possible as the breast is unlikely to produce milk. Many women have successfully breast-fed from the unaffected breast. Changes in breast size through pregnancy and breast feeding causing an increase in breast asymmetry may be corrected by using a ‘bra-filler’.
To discuss individual needs for bras to accommodate breastfeeding, a specialist in post-breast surgery lingerie products is recommended. Ask your Breast Care Nurse for suitable fitters in your area.
Three stores in Perth WA specialising in post-breast surgery bras include:
>> Breast Care WA - (Angela)
Tel: 1300 791 137; (08) 9361 1300
website: www.breastcarewa.com.au
location: 31 Teddington Rd, Burswood
>> femme de femme (Lorraine)
Tel: (08) 9355 5444 or 0433 190 066
website: www.femmedefemme.com
location: Suite 23, 328 Albany Hwy, Victoria Park
>> Four Seasons (Carillon City)
Tel: (08) 9322 2907
website: www.fourseasonslingerieandswimwear.com.au
location: Upper Hay St level, Carillon City, Perth
Other sources of assistance would include a Lactation Consultant. Your GP, obstetrician or maternity hospital would be able to advise of a local lactation consultant.
USEFUL ARTICLES FOR DETAILED INFORMATION:
I’ve provided links to several articles that provide comprehensive information regarding this topic for further reading if you wish ...
‘Breast cancer in young women and its impact on reproductive function’, pubmed journal article
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2667113/?tool=pubmed
‘Breast cancer and fertility’, Cancer Australia website
http://canceraustralia.nbocc.org.au/breast-cancer/living-with-breast-cancer/breast-cancer-and-fertility
‘Fertility issues and breast cancer treatment - Factsheet’, Breast Cancer Care UK website
http://www2.breastcancercare.org.uk/sites/default/files/bcc28_fertility_issues_web.pdf
Goodness - what a lot of information! I hope some of this is useful for you Jo.
Also if anyone has any other comments to add for Jo or anyone else, please feel free ..
Love Glenys xxx
The Click Breast Care Nurse 
