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Breast Cancer and Fertility

  • Oncofertility (JS Jeruss, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

The increased availability of assisted reproductive technologies (ART) allows women with fertility issues to increase their chances of a successful pregnancy with the use of medications that, in some cases, increase circulating estrogens. There has been significant concern that the use of these medications will increase the risk of hormone-sensitive cancers such as breast, ovarian and uterine malignancies. Additionally, for those women who are diagnosed with a breast cancer during their reproductive years, this diagnosis can be particularly difficult as future fertility is a major concern for many young breast cancer survivors. With the current available data, there does not appear to be a statistically significant increase in the risk of developing breast cancer with ART, although several series suggest a potential possible related increase in borderline ovarian and uterine cancers. For breast cancer survivors, there does not appear to be an increased risk of death associated with subsequent pregnancies when compared with breast cancer patients who did not have subsequent pregnancies, although waiting at least 2 years after the diagnosis of breast cancer potentially may convey a protective effect. Therefore, when systemic therapy for breast cancer is recommended, early counseling and referral to a reproductive endocrinologist is warranted to provide optimal fertility preservation options. Further safety and outcomes studies are warranted for children.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as:• Of importance

  1. Anders CK, Hsu DS, Broadwater G, et al. Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol. 2008;26:3324–30.

    Article  PubMed  Google Scholar 

  2. Theriault RL, Litton JK, Mittendorf EA, et al. Age and survival estimates in patients who have node-negative T1ab breast cancer by breast cancer subtype. Clin Breast Canc. 2011;11:325–31.

    Article  Google Scholar 

  3. Nixon AJ, Neuberg D, Hayes DF, et al. Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol. 1994;12:888–94.

    PubMed  CAS  Google Scholar 

  4. Gnerlich JL, Deshpande AD, Jeffe DB, et al. Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease. J Am Coll Surg. 2009;208:341–7.

    Article  PubMed  Google Scholar 

  5. Gonzalez-Angulo A, Broglio K, Kau S-W, et al. Women age < 35 years with primary breast carcinoma. Cancer. 2005;103:2466–72.

    Article  PubMed  Google Scholar 

  6. Anders CK, Fan C, Parker JS, et al. Breast carcinomas arising at a young age: unique biology or a surrogate for aggressive intrinsic subtypes? J Clin Oncol. 2011;29:e18–20.

    Article  PubMed  Google Scholar 

  7. Early Breast Cancer Trialists' Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365:1687–717.

    Article  Google Scholar 

  8. Partridge AH. Fertility preservation: a vital survivorship issue for young women with breast cancer. J Clin Oncol. 2008;26:2612–3.

    Article  PubMed  Google Scholar 

  9. Partridge AH, Gelber S, Peppercorn J, et al. Web-based survey of fertility issues in young women with breast cancer. J Clin Oncol. 2004;22:4174–83.

    Article  PubMed  Google Scholar 

  10. Mueller B, Simon M, Deapen D, et al. Childbearing and survival after breast carcinoma in young women. Cancer. 2003;98:1131–40.

    Article  PubMed  Google Scholar 

  11. Velentgas P, Daling J, Malone K, et al. Pregnancy after breast carcinoma. Cancer. 1999;85:2424–32.

    Article  PubMed  CAS  Google Scholar 

  12. Kroman N, Jensen M-B, Melbye M, et al. Should women be advised against pregnancy after breast-cancer treatment? Lancet. 1997;350:319–22.

    Article  PubMed  CAS  Google Scholar 

  13. Lee SJ, Schover LR, Partridge AH, et al. American society of clinical oncology recommendations on fertility preservation in cancer patients. J Clin Oncol. 2006;24:2917–31.

    Article  PubMed  Google Scholar 

  14. Schedin P. Pregnancy-associated breast cancer and metastasis. Nat Rev Cancer. 2006;6:281–91.

    Article  PubMed  CAS  Google Scholar 

  15. Anderson W, Matsuno R, Sherman M, et al. Estimating age-specific breast cancer risks: a descriptive tool to identify age interactions. Canc Causes Contr. 2007;18:439–47.

    Article  Google Scholar 

  16. Gail MH, Brinton LA, Byar DP, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst. 1989;81:1879–86.

    Article  PubMed  CAS  Google Scholar 

  17. Burkman RT, Tang MT, Malone KE, et al. Infertility drugs and the risk of breast cancer: findings from the National Institute of Child Health and Human Development Women's Contraceptive and Reproductive Experiences Study. Fertil Steril. 2003;79:844–51.

    Article  PubMed  Google Scholar 

  18. Kallen B, Finnstrom O, Lindam A, et al. Malignancies among women who gave birth after in vitro fertilization. Hum Reprod 26:253–8, 2010.

    Article  PubMed  Google Scholar 

  19. Jensen A, Sharif H, Svare EI, et al. Risk of breast cancer after exposure to fertility drugs: results from a large Danish Cohort study. Canc Epidemiol Biomarkers Prev. 2007;16:1400–7.

    Article  CAS  Google Scholar 

  20. Jensen A, Sharif H, Kjaer SK. Use of fertility drugs and risk of uterine cancer: results from a large danish population-based cohort study. Am J Epidemiol. 2009;170:1408–14.

    Article  PubMed  Google Scholar 

  21. dos Santos Silva I, Wark PA, McCormack VA, et al. Ovulation-stimulation drugs and cancer risks: a long-term follow-up of a British cohort. Br J Cancer. 2009;100:1824–31.

    Article  PubMed  CAS  Google Scholar 

  22. van Leeuwen FE, Klip H, Mooij TM, et al. Risk of borderline and invasive ovarian tumours after ovarian stimulation for in vitro fertilization in a large Dutch cohort. Human Reproduction 26:3456–3465, 2011.

    Article  PubMed  Google Scholar 

  23. Zreik TG, Mazloom A, Chen Y, et al. Fertility drugs and the risk of breast cancer: a meta-analysis and review. Breast Cancer Res Treat. 2010;124:13–26.

    Article  PubMed  Google Scholar 

  24. Goodwin PJ, Ennis M, Pritchard KI, et al. Risk of menopause during the first year after breast cancer diagnosis. J Clin Oncol. 1999;17:2365–70.

    PubMed  CAS  Google Scholar 

  25. Sukumvanich P, Case LD, Van Zee K, et al. Incidence and time course of bleeding after long-term amenorrhea after breast cancer treatment. Cancer. 2011;116:3102–11.

    Article  Google Scholar 

  26. Byrne J, Fears TR, Gail MH, et al. Early menopause in long-term survivors of cancer during adolescence. Am J Obstet Gynecol. 1992;166:788–93.

    PubMed  CAS  Google Scholar 

  27. Partridge A, Gelber S, Gelber RD, et al. Age of menopause among women who remain premenopausal following treatment for early breast cancer: long-term results from International Breast Cancer Study Group Trials V and VI. Eur J Cancer. 2007;43:1646–53.

    Article  PubMed  Google Scholar 

  28. Partridge AH, Ruddy KJ, Gelber S, et al. Ovarian reserve in women who remain premenopausal after chemotherapy for early stage breast cancer. Fertil Steril 94:638–44, 2010.

    Article  PubMed  Google Scholar 

  29. Peate M, Meiser B, Friedlander M, et al. It's now or never: fertility-related knowledge, decision-making preferences, and treatment intentions in young women with breast cancer: an Australian Fertility Decision Aid Collaborative Group Study. J Clin Oncol. 2011;29:1670–7.

    Article  PubMed  Google Scholar 

  30. Lee S, Ozkavukcu S, Heytens E, et al. Value of early referral to fertility preservation in young women with breast cancer. J Clin Oncol. 2010;28:4683–6.

    Article  PubMed  Google Scholar 

  31. Gelber S, Coates AS, Goldhirsch A, et al. Effect of pregnancy on overall survival after the diagnosis of early-stage breast cancer. J Clin Oncol. 2001;19:1671–5.

    PubMed  CAS  Google Scholar 

  32. Verkooijen HM, Lim GH, Czene K, et al. Effect of childbirth after treatment on long-term survival from breast cancer. British Journal of Surgery 97:1253–1259, 2010.

    Article  PubMed  CAS  Google Scholar 

  33. Azim Jr HA, Santoro L, Pavlidis N, et al. Safety of pregnancy following breast cancer diagnosis: A meta-analysis of 14 studies. European Journal of Cancer 47:74–83, 2010.

    Article  PubMed  Google Scholar 

  34. Valachis A, Tsali L, Pesce L, et al. Safety of pregnancy after primary breast carcinoma in young women: a meta analysis to overcome bias of healthy mother effect studies. Obstet Gynecol Surv. 2011;65:786–93.

    Article  Google Scholar 

  35. Ives A, Saunders C, Bulsara M, et al. Pregnancy after breast cancer: population based study. BMJ. 2007;334:194.

    Article  PubMed  Google Scholar 

  36. Braems G, Denys H, De Wever O, et al. Use of tamoxifen before and during pregnancy. The Oncologist, 2011.

  37. The Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Tecnology. Ovarian tissue and oocyte cryopreservation. Fertil Steril. 2008;90:S241–6.

    Google Scholar 

  38. Oktay K, Türkçüoglu I, Rodriguez-Wallberg KA. Four spontaneous pregnancies and three live births following subcutaneous transplantation of frozen banked ovarian tissue: What is the explanation? Fertil Steril. 2011;95:804.e7–804.

    Article  Google Scholar 

  39. Donnez J, Squifflet J, Jadoul P, et al. Pregnancy and live birth after autotransplantation of frozen-thawed ovarian tissue in a patient with metastatic disease undergoing chemotherapy and hematopoietic stem cell transplantation. Fertil Steril. 2011;95:1787.e1–4.

    Article  Google Scholar 

  40. Azim AA, Costantini-Ferrando M, Oktay K. Safety of fertility preservation by ovarian stimulation with letrozole and gonadotropins in patients with breast cancer: a prospective controlled study. J Clin Oncol. 2008;26:2630–5.

    Article  PubMed  CAS  Google Scholar 

  41. Oktay K, Kim JY, Barad D, et al. Association of BRCA1 mutations with occult primary ovarian insufficiency: a possible explanation for the link between infertility and breast/ovarian cancer risks. J Clin Oncol. 2010;28:240–4.

    Article  PubMed  CAS  Google Scholar 

  42. Pal T, Keefe D, Sun P, et al. Fertility in women with BRCA mutations: a case-control study. Fertil Steril. 2009;93:1805–8.

    Article  PubMed  Google Scholar 

  43. Smith KR, Hanson HA, Mineau GP, et al. Effects of BRCA1 and BRCA2 mutations on female fertility. Proc Biol Sci, epub, Oct. 26, 2011.

  44. Kotsopoulos J, Librach C, Lubinski J, et al. Infertility, treatment of infertility, and the risk of breast cancer among women with BRCA1 and BRCA2 mutations: a case–control study. Canc Causes Contr. 2008;19:1111–9.

    Article  Google Scholar 

  45. Wang WH, Kaskar K, Gill J, et al. A simplified technique for embryo biopsy for preimplantation genetic diagnosis. Fertil Steril. 2008;90:438–42.

    Article  PubMed  Google Scholar 

  46. Menon U, Harper J, Sharma A, et al. Views of BRCA gene mutation carriers on preimplantation genetic diagnosis as a reproductive option for hereditary breast and ovarian cancer. Hum Reprod. 2007;22:1573–7.

    Article  PubMed  CAS  Google Scholar 

  47. Sagi M, Weinberg N, Eilat A, et al. Preimplantation genetic diagnosis for BRCA1/2—a novel clinical experience. Prenat Diagn. 2009;29:508–13.

    Article  PubMed  CAS  Google Scholar 

  48. Wang CW, Hui EC. Ethical, legal and social implications of prenatal and preimplantation genetic testing for cancer susceptibility. Reprod Biomed Online. 2009;19 Suppl 2:23–33.

    Article  PubMed  CAS  Google Scholar 

  49. Hawkins M. Pregnancy outcome and offspring after childhood cancer. BMJ. 1994;309:1034.

    Article  PubMed  CAS  Google Scholar 

  50. Dalberg K, Eriksson J, Holmberg L. Birth outcome in women with previously treated breast cancer–a population-based cohort study from Sweden. PLoS Med. 2006;3:e336.

    Article  PubMed  Google Scholar 

  51. Langagergaard A. Birth outcome in women with breast cancer, cutaneous malignant melanoma, or Hodgkin's Disease: a review. Clin Epidemiol. 2011;3:7–19.

    Google Scholar 

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Authors and Affiliations

  1. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1354, Houston, TX, 77030, USA

    Jennifer K. Litton MD

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  1. Jennifer K. Litton MD
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Correspondence to Jennifer K. Litton MD.

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Litton, J.K. Breast Cancer and Fertility. Curr. Treat. Options in Oncol. 13, 137–145 (2012). https://doi.org/10.1007/s11864-012-0185-5

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  • DOI: https://doi.org/10.1007/s11864-012-0185-5

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