7 October 2019

Breast Cancer and Pregnancy after treatment

Medical Director
Cesar Diaz-Garcia
MD PhD Assoc Prof
IVI London

 

Any woman diagnosed with breast cancer is bound to be filled with worries about the impact of the disease on her life and her future. This is understandable and inevitable. Breast cancer is more common in post-menopausal women but far from rare in younger women and for them, the impact on fertility and any subsequent pregnancy could be a concern. Fears for the future can be intensified by some of the stories that circulate about infertility, how long you need to wait after treatment, or even the chances of passing on your illness to your child.

In this article we address some of those stories, fears and worries. We untangle the mistaken beliefs from the actual risks by examining them one by one, taking a cool look at pregnancy after breast cancer myths and facts.

Myth: breast cancer treatment results in infertility

The truth is that some treatments for some cancers can result in reduced fertility or even complete infertility. But the outcome depends on the type and severity of the cancer, the type of treatment and the age of the patient Different regimes of chemotherapy can have different effects of the ovary: while some will have little or no effect, others will cause early menopause by damaging the follicles (which contain the eggs) and also the surrounding tissue. Moreover, chemotherapy, while not necessarily having a direct impact on future pregnancy, brings some dangers. It can weaken the heart, making pregnancy more difficult for the mother, and it can cause an early menopause with the cessation of ovulation.

Other treatments such as hormone therapy, can cause irregular periods or even complete cessation of ovulation. Fortunately, for many women periods start again afterwards and they remain fertile.

Whichever treatment is recommended; it is vital that you talk to your medical advisers about your chances of pregnancy after treatment for breast cancer.

Myth: You must not get pregnant for five years after treatment

This too depends on the type of treatment and the decision always need to be individualized. After a course of chemotherapy, some medical advisers recommend a delay of six months before trying for pregnancy while others might recommend a delay of two to five years, as recurrence is likely higher during this time and if a further treatment was needed, being pregnant would be a problem.

Hormone therapy tends to be more long term and could last between five and ten years. Of course, for many people this would represent a major obstacle, since the age of natural menopause could be approaching after such a delay. However, it can be possible to take a break from hormone therapy for the duration of the pregnancy and then resume after the birth. Naturally, this is an area for individual specialist advice.

Myth: Your child is more likely to suffer from the same illness

Most breast cancers are not hereditary but are the result of mutations which occur during a person’s lifetime, rather than from genetic factors. There is no evidence from research that the offspring of breast cancer survivors have any increased chance of birth defects or long-term health issues. There are some less frequent cases where a cancer can be passed on genetically to children and so clearly you would need to seek advice from a genetic specialist about whether or not this is a risk in your circumstances.

Myth: You can’t breastfeed after breast cancer treatment

The fact is that many women who have become pregnant after treatment for breast cancer are able to breastfeed normally. For some people there could be issues following surgery or radiotherapy, and it is possible that structural changes in the breast tissue could cause a reduction in milk production or difficulties for the baby to latch on to the breast. The only clear-cut instance of not being able to breastfeed would apply to women who need to resume hormone therapy after the birth.

Myth: If treatment is urgent, there’s no time to preserve fertility

This is fast becoming one of the most outdated myths around breast cancer and pregnancy after treatment. It is true that the most straightforward procedure to preserve fertility in advance of treatment starting is the vitrification of oocytes and this involves ovarian stimulation over a period of several weeks. However, fertility specialists recognise that there is not always time to follow the normal IVF process, and other options are available. These include:

Random or luteal phase stimulation

Some studies show that, while usual protocols for ovarian stimulation have to be started by the beginning of the cycle, it is possible to undergo a stimulation treatment with positive outcomes starting the stimulation at any time of the cycle. Likewise, dual stimulation protocols also allow women to undergo two rounds of IVF within one cycle, accumulating or freezing a higher number of eggs in less time. Last but not least, there are specific protocols where the use of specific adjuvant medications helps to reduce the hormone levels in the body to minimize the risk or impact of these hormones.

Freezing of the ovarian cortex

This is a comparatively new technique which has been used successfully around the world. This method might be considered to help restoring the ovarian function so that natural conception or a normal IVF procedure can take place at a later time. It is particularly helpful for cancer patients who need to start a course of radiotherapy or chemotherapy immediately.

In vitro maturation of oocytes (IVM)

IVM is another technique that can be considered when there is insufficient time available for the normal IVF process. With this method, immature oocytes are retrieved from ovarian follicles. These are cultivated to a stage of maturity in the laboratory and can then be preserved for later use.

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