Chemotherapy is known to negatively impact the reproductive potential of young breast cancer patients. However, its effects on fertility after treatment in women are still poorly understood. A stud presented at the ESMO Congress 201
The conservation of fertility today is based on the removal and freezing of eggs or embryos after in vitro fertilization. Usually, breast cancer patients under the age of 40 are offered during the first post-diagnosis consultations. Worldwide, women in this age group represent less than 7% of breast cancer diagnoses and survivors are 70% less likely to become pregnant than the general population. Dr. Jerome Martin-Babau of Center Armoricain de Radiotherapie, Imagerie Medicale et Oncologie in Plerin, France, explains, "The main obstacle to accessing fertility maintenance measures for patients in France is that laboratories and medical expertise are only available in larger hospitals. Women may have to travel further than their usual cancer center for the procedure. "
The French National Cancer Plan sees this solution as a key service to be rolled out nationwide. "We wanted to find out if the need and demand for breast cancer survivors meets the level of investment and organization demanded by the politicians," continued Martin-Babau.
During the course of the study, 96 eligible patients between 18 and 40 years of age treated for chemotherapy for non-metastatic breast cancer were identified – 60 agreed to participate in the study. "We based our questionnaire on existing literature-based tools and added a separate section on changes in patient menstrual cycles," said Martin-Babau.
The mean age of participants to the diagnosis was 36 years and the median time between the end of their chemo and participation in the study was 57 months. In more than half of the cases, the cancer had spread to the lymph nodes at the time of diagnosis, resulting in an increased risk of recurrence. Three-fold negative tumors were diagnosed in 10 women: their prognosis is worsened by the inability to receive the most commonly prescribed antihormonal treatment after chemotherapy. All patients, however, were in complete remission at the time of the study.
The results showed that 83% of participants had experienced amenorrhea – a total absence of menstruation – during their treatment with chemotherapy. "That was an expected result," said Martin-Babau. "What we did not expect was that 86% of these patients returned to their normal menstrual cycle within the following year after the end of chemotherapy, indicating that the treatment had not completely damaged their ovaries."
Evolution Patients' desire to give birth to children during the course of the illness was also evaluated: more than a third of women reported that they wanted to become pregnant before starting treatment. In contrast, only one in ten said that they still had this desire to end their chemotherapy.
"Of the six patients who still wanted to have children, four women actually managed to get pregnant, though two were eventually absent," reported Martin-Babau. The assumption that it is difficult to achieve pregnancy after breast cancer was thus refuted in this cohort of patients.
"Of course, our study was limited to one center and reflects the activity of a few physicians – the reality may be quite true elsewhere, and a third of the patients we identified did not respond to the survey, possibly because of frustration over their personal lives Your participation could have changed our results, "warns Martin-Babau.
"The fact is that most forms of breast cancer are stimulated by hormones, and the implantation of in vitro-produced embryos requires women to take extra hormones that could potentially play a role in the disease's recurrence," we currently have limited data to alleviate this concern. "
" In a context where it turns out that natural pregnancies are still possible after treatment and where the actual demand for fertility maintenance is. The measures appear to be relatively low, and we as clinicians need to think about it as we do while providing on-line fertility advice to these young patients can provide as balanced information as possible, "he said.
Commentary on the study for ESMO, Dr. Matteo Lambertini, ESMO Scholar at the Jules Bordet Institute in Brussels, Belgium, said:" Earlier data (5,6) have shown that only a small proportion of women undergo fertility preservation at the time of breast cancer diagnosis. The results, which are based on a small patient cohort, also show us that the desire of having breast cancer survivors to have children declines until the end of treatment, while at the same time confirming that natural pregnancies are still possible after chemotherapy. However, this does not mean that oncologists should not discuss fertility treatments with their patients, even in cases where their cancer center does not offer on-site fertility services: in fact, the minority of interested women like to travel to the nearest one facility, that works. "
" As physicians, we must discuss with each of our breast cancer patients the potential loss of ovarian function and fertility, as we would with any other side effect of treatment: as early and as comprehensive as possible, "added Lambertini. It is important for oncologists to be aware of the existing ESMO Clinical Practice Guidelines on the subject (7) and to be attuned to each patient's specific circumstances. While this study reminds us that the need for fertility measures should not be overestimated, we should also be careful not to exaggerate the risk of such a process for women if we offer them these opportunities. "
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