Breast cancer is the most common cancer in women under 40 years, and therefore reproductive age. If during a testicular cancer or cancer of the ovaries or uterus, is thought systematically to lower fertility, nothing is proposed at a breast cancer to preserve ovarian function. But treatments like chemotherapy can induce amenorrhea (no rules) temporary or permanent or worse early menopause irreversible. Hormone therapy proposed for premenopausal women is tamoxifen, which is not held responsible for infertility. It is usually prescribed for 5 years as a contraceptive and even back then the possibility of pregnancy, which obviously poses problems for women close to forty. After treatment there are between 5 and 28% of spontaneous pregnancies is to say the risk is as important and major issue.
Today, when ovarian function is disrupted proposes some solutions:
* The use of egg donation – but legislation in France makes this technique extremely difficult to achieve because the gift is free, and very few women are willing to be donors.
* Hosting a supernumerary embryo of a couple who performed IVF (In Vitro Fertilization) – solution in France, aimed at couples who are facing a double infertility (male / female)
* Adoption
But these three possibilities are conceivable if the woman has a spouse! And in any case they are really acceptable?
But solutions exist upstream:
* The freezing of embryos, first: after ovarian stimulation before chemotherapy, oocytes collected are confronted with the sperm of the spouse. After IVF the embryos were frozen for subsequent reimplantation. If this solution still requires a spouse, it is particularly an issue of medical importance. Indeed, the impact of ovarian stimulation on the risk of recurrence is not known at this time. This technique gives 20 to 30% of success.
* The freezing of oocytes: after ovarian stimulation again, this time is frozen oocytes obtained (like sperm in men). If the problem persists risk of recurrence, a single woman can easily use this solution. But the success rate in this case is very low (around 3%) because of technical problems due to freezing / thawing.
* The ovarian cryopreservation: before treatment, one ovary is removed wholly or partially by laparoscopy and frozen. A range of care, ovarian or fragment will be relocated in the pelvis or in the forearm! An egg can grow spontaneously or after stimulation. After IVF, the embryo is reimplanted in the uterus. But this technique is experimental and only two pregnancies have been recorded to date. Moreover, this solution presents a risk of reintroduction of malignant cells (metastatic ovarian) is significant (especially for breast cancer stage IV, and infiltrating lobular carcinomas). On the other hand, offer a very partial oophorectomy in a patient for whom treatment would not infertilisant (the risk of infertility vary from woman to woman) is not ethically acceptable.
* The last solution would of course, to propose a less infertilisante hormone instead of the commonly prescribed adjuvant chemotherapy in young women.
It is therefore clear that the problem exists and should not be downplayed by the medical profession. It is, in my opinion, extremely important to discuss this significant risk to patients so they can consider a solution, even if what we proposed, so far, not ideal by any means.
Tags: Breast cancer, Cancer, Chemotherapy, Fertility, Treatments, Women, Women under 40 years
