Pregnancy possible after chemotherapy for breast cancer patients, but many do not want it anymore

Chemotherapy is known to have a negative impact on the reproductive potential of young patients with breast cancer. Its effects on post-treatment fertility of women are, however, still poorly understood. A study to be presented at the ESMO 2018 congress in Munich confirmed that natural pregnancies are possible after chemotherapy, but that the desire of survivors to have children diminishes considerably after treatment, questioning the need for breastfeeding. systematic use of measures to preserve fertility.

The preservation of fertility today rests on the harvesting and freezing of eggs or embryos after in vitro fertilization. It is usually offered to breast cancer patients under the age of 40 during the first consultations following the diagnosis. Globally, women in this age group account for less than 7% of breast cancer cases and survivors are 70% less likely to become pregnant than the general population. According to the author of the study, Dr. Jerome Martin-Babau of the Armorican Center for Radiotherapy, Imaging and Oncology of Plerin, France, "the main obstacle to access to fertility preservation measures for patients in France. France is the need to have laboratories and experts available only in large hospitals.Women may have to move further than their usual cancer center for the procedure. "

The French National Cancer Control Plan considers this solution as a key service to be deployed nationwide. "We wanted to know if the need and demand of breast cancer survivors matched the level of investment and organization required by policymakers," Martin Babau continued.

During the study, 96 eligible patients aged 18 to 40 years and treated with chemotherapy for non-metastatic breast cancer were identified – 60 agreed to participate in the survey. "We based our questionnaire on existing tools in the literature and added a section devoted to changes in the patient's menstrual cycle," said Martin Babau.

The median age of the participants at the time of diagnosis was 36 years and the median time between the end of their chemotherapy and their 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, hence a higher risk of recurrence. Triple negative tumors have been diagnosed in 10 women: their prognosis is aggravated by the fact that they can not receive the anti-hormonal treatment usually prescribed after chemotherapy. However, all patients were in complete remission at the time of the survey.

The results showed that 83% of participants had amenorrhea – a complete absence of menstruation – during their chemotherapy treatment. "It was an expected discovery," Martin-Babau said. "What we did not expect was that 86% of these patients also reported that their menstrual cycle was back to normal in the year following the end of chemotherapy, indicating that the treatment had not completely damaged their ovaries. "

The evolution of the willingness of patients to give birth to children during the course of the disease course was also assessed: more than a third of women reported planning a pregnancy before starting treatment. In contrast, only one in ten said he still had this wish after the end of his chemotherapy.

"Of the six patients who still wanted to have children, four women managed to get pregnant, but two ended up miscarried," Babau said. The hypothesis that it is difficult to reach a pregnancy naturally after breast cancer has therefore been belied in this cohort of patients.

"Of course, our study was limited to one center and reflected the activity of a few physicians.The reality may be very different elsewhere.Also, one-third of the patients we identified have not responded to the survey. Investigation, probably because of the frustration with their personal situation.Their participation may have changed our results, "warned Martin-Babau.

Drawing conclusions from the findings, he observed, "The fact is that most forms of breast cancer are stimulated by hormones." The implantation of embryos produced in vitro forces women to take hormones. that could potentially play a role in the recurrence of the disease – we currently have limited data to mitigate this problem. "

"In a context, then, where it turns out that natural pregnancies are still possible after treatment, and where the actual demand for fertility preservation measures seems relatively low, we as clinicians have to think how to provide the most balanced information possible during the onco-fertility consultation of these young patients, "he said.

Matteo Lambertini, a fellow at the Jules Bordet Institute in Brussels (Belgium), commented on the study: "The previous data (5,6) showed that only a small proportion of women choose to undergo conservation measures. At the time of the diagnosis of breast cancer, the current results, although based on a small cohort of patients, further indicate that the desire of breast cancer survivors to have children decreases at the end of treatment. While confirming that natural pregnancies are always possible afterwards, this does not mean that oncologists should not talk about fertility preservation measures for their patients, even in cases where their cancer center does not have a cure. offers no on-site fertility services: indeed, the minority of interested women will be pleased to visit the nearest facility that does. "

"As physicians, we must continue to discuss the potential loss of ovarian function and fertility with each of our breast cancer patients, as we would with any other side effect of treatment: the earliest and as much as possible, "said Lambertini. . "It is important for oncologists to be aware of the ESMO clinical practice guidelines on the subject (7) and to be sensitive to the particular circumstances of each patient.This study reminds us that the need for fertility preservation measures must not be overestimated, we must also be careful not to overstate the risk of such a procedure for women when we offer them these options. "

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