For several years October has become the flagship month for the fight against breast cancer, therefore it is important for us to take advantage of this space to touch on the different aspects related to this issue from the point of view of fertility.
With the progress and current evolution of adjuvant therapy, the constant of recurrence and mortality rate associated with breast cancer has significantly decreased in the last 10 years. Therefore, today vital importance is given to issues that previously did not seem important, such as quality of life later, reproductive desire and survival, especially in women diagnosed at younger ages.
As reported by the National Intuit of Cancerology (INC) and the National Administrative Department of Statistics (DANE) breast cancer is considered the fifth cause of death in women and is the first according to type of cancer in Colombia, with an approximate global annual incidence of 31.2 per 100.00 women and a mortality of 10 per 100,000.
Hundreds of campaigns and methods to make women aware of the importance of breast self-examination and consulting early have led us to increasingly earlier diagnoses and early treatments, with 5-year survival rates quite encouraging. For all this, it is possible to speak with complete peace of mind about the search for pregnancy after breast cancer, this aspect being today an integral part of treatment, in which it is important to inquire about the desire for future maternity and recommend management before establishing cancer treatment to carry out the preservation of fertility (either oocytes or embryos).
The path from the diagnosis of breast cancer to the cure and the subsequent search for pregnancy is a time of doubts and fears, where the continuous accompaniment and the search for “responses” must be the cornerstone, each stage carries its own story and from our point of view the first step It is aimed at understanding that the preservation of fertility is possible, it is a fact and we can achieve it through different treatment schemes aimed at protecting the oocytes prior to cancer treatment, so it is vital to know each of the key points throughout this path:
Prior to cancer management:
When making the diagnosis, it is important that the clinical oncologist report on the possibility of vitrifying gametes prior to the management of cancer, it must be taken into account that it is a safe procedure, it does not generate associated comorbidity, the beginning of ovarian stimulation is carried out regardless of the moment of the menstrual cycle; The key premise is to associate medication that will keep hormone levels (estrogens) as low as possible and, above all, this treatment does not delay oncological management.
Time between cancer treatment and pregnancy search:
In the literature there is no clear time between the completion of cancer treatment and the search for a pregnancy; Associations such as the American Cancer Society (ACS) recommend having a minimum of two years as a waiting period, arguing that it is the indicated time to identify any regression of the cancer and thus act early. However, it is important to individualize this period of time taking into account the initial commitment of the breast, management, age and hormonal context.
Pregnancy and breast cancer:
Personally, I consider that one of the most latent concerns in these patients, which goes hand in hand with a globalized cultural belief where pregnancy is considered a risk factor that increases the chances of presenting some type of complication or regression of the disease.
Much has been said about hormone-sensitive tumors (estrogens) and being pregnancy a stage of great hormonal influence could have a negative effect for a woman with a history of breast cancer, however, today studies have shown that there is no such association, therefore which is a safe stage which they can enjoy to the fullest.
Lactation:
In this area, it is important to take into account the type of surgical treatment carried out for the management of cancer, which is related to the severity of the condition, histological type and commitment, therefore it is not a constant and should be individualized in each patient. Likewise, during this period, hormonal changes are considered safe and do not impose risk for the patient with a history of breast cancer in terms of recurrence.
In conclusion, you need to know that you have options; Many times the diagnosis of breast cancer arrives and you have not wondered if you want to have children or your priorities are different and now more than ever you have to focus on your health, there will always be the“perhaps”,the“I have never thought of it” or the“I don’t see myself as a mother”And many others the illusion of motherhood has always been part of you.
Therefore, you can achieve the dream of being a mother with the right direction, you do not have to carry more weight on your shoulders or turn your future projects into fears, you have enough to carry your disease like a warrior.
By Dr. German Ricardo Tovar Rodriguez