Purpose/Objectives: To describe the impact of treatment on fertility, discuss fertility-sparing options available for women with breast cancer, and explore pregnancy subsequent to breast cancer.
Data Sources: Published research, clinical articles, book chapters, and abstracts.
Data Synthesis: The risk of amenorrhea associated with alkylating agents in breast cancer survivors is well known. Fertility-sparing options before, during, and after treatment are possible with the use of assistive reproductive technology. Young breast cancer survivors are concerned about stimulating recurrence with subsequent pregnancy, health during pregnancy, and family matters.
Conclusions: Current data about the effects of treatment on amenorrhea, subsequent pregnancy after treatment, preservation of ovarian function during adjuvant therapy, and management of ovarian failure in young women with breast cancer are important to include in discussions and counseling.
Implications for Nursing: Young women deserve a thoughtful discussion about their concerns among their multidisciplinary team, including oncology nurses, oncologists, and social workers. Effects of treatment on fertility are well known. Women with fertility concerns should be referred to a reproductive endocrinology team at the time of diagnosis rather than after treatment has ended.
Anderson, R.A., Kinniburgh, D., & Baird, D. (1999). Preliminary experience of the use of a gonadotrophin-releasing hormone antagonist in ovulation induction/in-vitro fertilization prior to cancer treatment. Human Reproduction, 14, 2665-2668.
Baum, M., Buzdar, A., Cuzick, J., Forbes, J., Houghton, J., Howell, A., et al. (2003). Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early-stage breast cancer: Results of the ATAC (Arimidex, tamoxifen alone or in combination) trial efficacy and safety update analyses. Cancer, 98, 1802-1810.
Bines, J., Oleske, D., & Cobleigh, M. (1996). Ovarian function in premeno-pausal women treated with adjuvant therapy for breast cancer. Journal of Clinical Oncology, 14, 1718-1729.
Blakely, L.J., Buzdar, A.U., Lozada, J.A., Shullaih, S.A., Hoy, E., Smith, T.L., et al. (2004). Effects of pregnancy after treatment for breast carcinoma on survival and risk of recurrence. Cancer, 100, 465-469.
Dow, K.H. (1994). Having children after breast cancer. Cancer Practice, 2, 407-413.
Dow, K.H., Harris, J.R., & Roy, C. (1994). Pregnancy after breast-conserving surgery and radiation therapy for breast cancer [Monograph]. Journal of the National Cancer Institute, 16, 131-137.
Fertile Hope. (2001). Parenthood options: Donor embryos. Retrieved April 1, 2004, from http://www.fertilehope.org/resources/preservation_cat.cfm?CID=4#TID31
Fox, K., Scialla, H., & Moore, H. (2001). Preventing chemotherapy-related amenorrhea using leuprolide during adjuvant chemotherapy for early-stage breast cancer [Abstract]. Proceedings of the American Society of Clinical Oncology, 21, 98.
Gelber, S., Coates, A.S., Goldhirsch, A., Castiglione-Gertsch, M., Marini, G., Lindtner, J., et al. (2001). Effects of pregnancy on overall survival after the diagnosis of early-stage breast cancer. Journal of Clinical Oncology, 19, 1671-1675.
Goodwin, P.J., Ennis, M., Pritchard, K.I., Trudeau, M., & Hood, N. (1999). Risk of menopause during the first year after breast cancer diagnosis. Journal of Clinical Oncology, 17, 2365-2370.
Hensley, M.L., & Reichman, B.S. (1998). Fertility and pregnancy after adjuvant chemotherapy for breast cancer. Critical Reviews in Oncology/Hematology, 28, 121-128.
Hershlag, A., & Schuster, M. (2002). Return of fertility after autologous stem cell transplantation. Fertility and Sterility, 77, 419-421.
Ibrahim, N.K., Macneil, S., Headley, J.A., Bisotooni, K.T., Buzdar, A.U., & Hortobagyi, G.N. (2003, June). Effect of paclitaxel (P)-based chemotherapy on the ovarian failure (OF) of breast cancer patients (pts): A retrospective study. Paper presented at the meeting of the American Society of Clinical Oncology, Chicago, IL.
Koyama, H., Wada, T., Nishizawa, Y., Iwanaga, T., & Aoki, Y. (1977). Cyclophosphamide-induced ovarian failure and its therapeutic significance in patients with breast cancer. Cancer, 39, 1403-1409.
Kroman, N., Jensen, M., Melbye, M., Wohlfahrt, J., & Mouridsen, H.T. (1997). Should women be advised against pregnancy after breast cancer treatment? Lancet, 350, 319-322.
Lower, E., Blau, R., Gazder, P., & Tummala, R. (1999). The risk of premature menopause induced by chemotherapy for early breast cancer. Journal of Women's Health and Gender-Based Medicine, 8, 949-954.
Meirow, D. (2000). Reproduction post-chemotherapy in young cancer patients. Molecular and Cellular Endocrinology, 169, 123-131.
Meirow, D., & Nugent, D. (2001). The effects of radiotherapy and chemotherapy on female reproduction. Human Reproduction Update, 7, 535-543.
Moore, H. (2000). Fertility and the impact of systemic therapy on hormonal status following treatment for breast cancer. Current Oncology Reports, 2, 587-593.
Oktay, K., Buyuk, E., Davis, O., Yermakova, I., Veeck, L., & Rosenwaks, Z. (2003). Fertility preservation in breast cancer patients: IVF and embryo cryopreservation after ovarian stimulation with tamoxifen. Human Reproduction, 18(1), 90-95.
Sankila, R., Heinavaara, S., & Hakulinen, T. (1994). Survival of breast cancer patients after subsequent term pregnancy: "Healthy mother effect." American Journal of Obstetrics and Gynecology, 170, 818-823.
Schover, L.R., Brey, K., Lichtin, A., Lipshultz, L.I., & Jeha, S. (2002). Knowledge and experience regarding cancer, infertility, and sperm banking in younger male survivors. Journal of Clinical Oncology, 20, 1880-1889.
Stone, E., Slack, R., Novielli, A., Ellis, M., Baidas, S., Gelmann, E., et al. (2000). Rate of chemotherapy-related amenorrhea (CRA) associated with adjuvant Adriamycin and cytoxan (AC) and Adriamycin and cytoxan followed by Taxol (AC + T) in early stage breast cancer [Abstract 224]. Breast Cancer Research and Treatment, 64(1), 61.
Sutton, R., Buzdar, A., & Hortobagyi, G. (1990). Pregnancy and offspring after adjuvant chemotherapy in breast cancer patients. Cancer, 65, 847-850.
Velentgas, P., Daling, J.R., Malone, K.E., Weiss, N.S., Williams, M.A., Self, S.G., et al. (1999). Pregnancy after breast carcinoma: Outcomes and influence on mortality. Cancer, 85, 2424-2432.
von Schoultz, E., Johansson, J., Wilking, N., & Rutqvist, L.E. (1995). Influence of prior and subsequent pregnancy on breast cancer prognosis. Journal of Clinical Oncology, 13, 430-434.
White, T. (1955). Carcinoma of the breast in the pregnant and nursing patient. American Journal of Obstetrics and Gynecology, 68, 1277-1286.