Considering a Baby After Breast Cancer
Hester Hill Schnipper, LICSW, OSW-C Program Manager Emeritus, Oncology, Social Work
APRIL 30, 2021
More than 12,000 women under 40 are diagnosed with breast cancer in the United States each year. Although it is rare, I have known several women who were in their 20s at the time of diagnosis and one who was 19. Many of these young women hope to have a child or more children, and the prospect of losing fertility is devastating. Some breast cancer treatments temporarily affect fertility while others have long-lasting impact.
Women with ER-positive breast cancers are treated with hormonal therapies. There are three that are approved for premenopausal women: tamoxifen, Evista (raloxifene), and Farestron (toremifene). All three cause menstrual cycles to become irregular or cease. Once the (often) five years of treatment are over, some women again have periods, but others don’t. Obviously if menses do not resume, pregnancy is not possible. Even if they do, some women have trouble conceiving after taking these drugs. One obvious factor is aging; five years makes a difference in a woman’s fertility even without breast cancer or other complications.
Some women are treated by having their ovaries shut down either by medicine or surgery. Often ovarian shutdown is accompanied by one of the aromatase inhibitors, the type of hormonal treatment that is used for post-menopausal women. If medicine has been used to stop ovarian function, it may or may not begin again when the drugs are stopped. If the ovaries have been surgically removed, obviously they are gone for good.
Finally, chemotherapy can disrupt or end menses. The closer one is to a normal menopause, the more likely it is that periods will not return post chemo. It is not impossible to still be fertile if menses do not resume, but it is more difficult and related to age.
These are painful concerns for younger women. Almost all of us would agree that treating the breast cancer is even more important than preserving fertility. Certainly, at the moment of diagnosis, our focus is on survival. As time passes, however, life continues and the wish for a baby may be intense. Talking with your doctor about egg preservation before beginning breast cancer therapy is important; this will involve working with an IVF team, and not all insurances will cover the cost. There may be financial help available through the Live Strong Foundation.
The Young Women’s Breast Cancer Study is a large multicenter project following women who were younger than 40 at the time of a breast cancer diagnosis between 2006 and 2016. Looking at a number of issues, a recent study published in Cancer described women’s interest in fertility and pregnancies within 5 years of their diagnoses. Of more than 1000 women, 36% wanted a child within five years of their illness. Reportedly, 130 women tried to conceive, and almost 70% had healthy pregnancies and healthy babies. As happens in life, 2% of the women who had not tried to conceive also became pregnant.
We have learned that many women want to have a baby five years or even more after breast cancer. In addition to the possible infertility issues, anyone post cancer must seriously consider her situation and supports. Ideally anyone considering a pregnancy, even without a serious medical history, thinks about her life and how a child can be raised and loved should she become incapacitated or die. Those of us who have grappled with our mortality know this all too well and must consider the realities. With a loving and responsible partner, the concerns are fewer. Women who are thinking about becoming single parents have a real obligation to think about the future, and to talk about these painful considerations with family or close friends. Blessedly, most women who are appropriately treated for breast cancer go on to have long and healthy lives, but none of us have a promise of that. Hoping and planning for our best lives means taking responsibility for our choices and those whom we love. I have known at least a dozen women who went on to have healthy pregnancies and healthy babies after breast cancer, and some of these babies are now in college.