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Saving Fertility

Posted 5/31/2014

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  This is a topic that is of huge importance to a rather small number of women with breast cancer. Being treated for breast cancer usually means that a woman's fertility is compromised or ended. Young woman who are diagnosed with breast cancer have all the same worries as their older sisters, but they must also contend with the loss of choice about their future families. For some women, this means having fewer children than planned, and for others, it means having no children at all. Losing a dream is very difficult, and this always feels like one more theft by this illness.

  Fertility is compromised in a couple of general ways: chemotherapy often ends menses for women 40 or older and sometimes does so for women in their late 30s; women with ER positive breast cancers then usually take Tamoxifen for at least five years (see the blog of two days ago for the report that this is likely to be ten years), and that ages them out of fertility. I have known a number of women who adopted children after breast cancer, and I know others who have gone on to have healthy pregnancies and healthy babies--but it is tricky and scary and difficult.

  This report from MedPage summarizes a study from the Cleveland Clinic; women with ER negative (and, yes, that is a big catch) breast cancers who received the hormone, goserlin, in addition to their other treatments had a 70% reduction in fertility loss. That is huge. Here is the start of the story and then a link to read more:

ASCO: Drug Helps Save Fertility in Breast Ca

CHICAGO -- Ovarian failure occurred 70% less often in women with hormone receptor-negative breast cancer treated with the hormonal agent goserelin in addition to chemotherapy, a randomized trial showed.

Women treated with goserelin had an ovarian failure rate of 8% by the most stringent definition, compared with 22% among women who did not receive the LHRH agonist in addition to chemotherapy, according to Halle C.P. Moore, MD, of the Cleveland Clinic, and colleagues. Similar results came from an analysis using a less strict definition of ovarian failure.

Moreover, treatment with goserelin was associated with improved disease-free survival and overall survival, they reported here at the American Society of Clinical Oncology. Patients treated with goserelin also had significantly more pregnancies, births, and multiple births.


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