Sun | Nov 18, 2018

Dear Doc | Is pregnancy possible after breast cancer treatment

Published:Sunday | October 14, 2018 | 12:00 AM

Q Dear Doc, I am very worried about my daughter. She was recently diagnosed with breast cancer and is getting ready to do surgery. She is in her mid-30s and has no children, so she is only removing the part of the breast with the cancer. Will she be able to have children in the future, and if so, what about breastfeeding, since she is removing part of the breast?

Please help. I am praying you can give us some hope.

A Dear Mother, your concern is very valid and I am very sorry to hear about your daughter. Here is some hope for both of you.

Many women are able to become pregnant after treatment for breast cancer, but some treatments can make it harder to get pregnant in the future. Many breast cancers are also sensitive to estrogen, so there has been concern that for women who have had breast cancer, the high estrogen hormone levels that result from a pregnancy might increase the chance of the cancer coming back. Studies have shown, though, that pregnancy does not increase the risk of the cancer coming back after successful treatment.

The most important thing to do if you want to have children after treatment, or even think that you might want to, is to talk to your doctor about fertility before you begin breast cancer treatment in order to keep your options open.

It is important that you talk with your doctor about fertility before starting breast cancer treatment. This is because some breast cancer treatments can affect a woman's fertility (ability to have a baby). Chemotherapy for breast cancer treatment, for example, may damage the ovaries, which can sometimes cause infertility. Many women are, however, still able to become pregnant after treatment, despite this fact.

A natural pregnancy is possible after cancer treatment. A woman's body may recover naturally and produce mature eggs that are suitable to be fertilised. It may, however, be recommend that a woman wait anywhere from between six months up to two years before trying to get pregnant. Waiting six months will help to reduce the risk of birth defects from eggs that may have been damaged by chemotherapy, or other treatments. The two-year period is suggested on the basis that the risk of the cancer coming back (recurring) is highest in the first two years after treatment.

Another option for future fertility is egg freezing (oocyte cryopreservation/egg banking)). It is an established method of preserving fertility in women. This is a good option for women who do not have a partner. The process of egg freezing involves mature eggs being removed from the ovary and freezing them. When the woman is ready to become pregnant, the eggs are thawed, fertilised, and implanted in her uterus.

Embryo freezing, or embryo cryopreservation, is another established and proven, successful method of preserving a woman's fertility. In comparison to egg freezing, in this process, mature eggs are removed from the woman's ovaries and fertilised in the lab. This is what is called in vitro fertilisation. The embryos are then frozen for use after cancer treatment. This option works well for women who already have a partner. Single women still have the option of freezing embryos by using donor sperm.

If those options aren't feasible, ovarian suppression during cancer treatment is another fertility-sparing method. Gonadotropin-releasing hormone agonists are hormonal medications that are used to put a woman into menopause temporarily. This results in the ovaries being shut down during cancer treatment to help protect them from its damaging effects. The hope is that reducing the activity in the ovaries during treatment will reduce the number of eggs that are damaged, so women are more likely to resume normal menstrual cycles after treatment.

Regarding breastfeeding after breast cancer treatment - after breast surgery and/or radiation, there may be problems with breastfeeding from the affected breast. These include reduced milk production in that breast and painful breastfeeding. It can also be difficult for the baby to latch on to the breast. Despite this, many women are still able to breastfeed.

There is also no proof that breastfeeding after breast cancer treatment increases the risk of the cancer coming back. It has actually been suggested that having a history of breastfeeding after cancer treatment might actually lower the risk of the cancer coming back.

But please, let your daughter talk to her doctor. Very often, patients get caught up in beating the cancer, they fail to see past that or even think about life after cancer, and lose track of what they still want out of life.

A support/counselling group can help you sort through the choices that come with surviving breast cancer and planning a pregnancy.

I hope I gave you the hope you sought.

deardoc@gleanerjm.com