By Dr. Pankaj Kumar Garg
An oncologist needs to answer this question more frequently, especially in the recent times due to perhaps two major reasons – (a) a surge in the number of young women having breast cancer, and (2) a shift in the childbearing age due to multiple socio-economic and demographic reasons. Breast cancer is the most common cancer in women in India and globally – one in four Indian women diagnosed with cancer has a breast tumor.
As per an estimate, around 1.78 lac Indian women were diagnosed with breast cancer in 2020, and almost 90 thousand women died of breast cancer in the same year. There were estimated to be 4.5 lac breast cancer cases in India in 2020. Recent trends suggest that breast cancer is increasingly being observed in young women (<40 years of age), almost 10-20% of the patients with breast cancer fall in this age group now.
Unfortunately, the majority of the breast tumors in young women are aggressive and diagnosed in advanced stages, requiring invariably cancer chemotherapy. However, in these young patients, cancer chemotherapy may result in premature ovarian insufficiency and impaired fertility. The currently used anticancer drugs in breast cancer carry the risk of on average 20% permanent ovarian function in patients who are younger than 40 years of age; however, some drugs affect fertility in a higher number of patients. Though almost all patients cease to have normal menstruation following initiation of cancer chemotherapy, the majority of them regain normal ovarian function by 9 months after the last chemotherapy session.
As per the internationally accepted norms, all young patients must undergo fertility counselling before undergoing anticancer treatment. However, in reality, fertility issues are hardly ever discussed and the whole focus is centred on anticancer treatment. Though men can quickly bank their sperms when they suffer from cancer, fertility preservation in women with breast cancer is a complicated issue. However, recent studies have reassured that fertility preservation is safe – currently, there are several potential options, including all available reproduction-assisted technologies, such as in vitro fertilization (IVF) and embryo transfer, in vitro maturation, freezing and preservation of eggs or embryos or ovarian tissue.
Breast cancer survivors can safely conceive and enjoy motherhood without having an increased risk of disease recurrence provided they are under the care of specialists. It is generally advised that pregnancy should be avoided for two years after completion of cancer treatment as chances of disease recurrence are highest in this period. Breast cancer survivors can safely breastfeed their kids, though it may not be possible from the affected breast due to surgery or low production. Some women are advised to take hormonal therapy for 5 to 10 years as a part of their cancer treatment, they must consult the oncologists about how long they need to stop their medicines during pregnancy and breastfeeding.
Fertility issues in breast cancer are complex; however, they must be discussed with the patient, oncologists, and fertility specialists prior to initiation of anticancer treatment. Remember, cancer is not the end of life but a beginning of a new purposeful chapter.
(The author is Professor and Head, Department of Surgical Oncology at Shri Guru Ram Rai Institute of Medical and Health Sciences and Shri Mahant Indiresh Hospital, Dehradun (Uttarakhand). Views expressed are personal and do not reflect the official position or policy of FinancialExpress.com.)