As we ended this past breast cancer awareness month (October), we celebrated the knowledge that we have gained about this alarming disease and how people have come together to create a unified effort in battling it.
Breast cancer in women is very common and affects 1 out of every 8 women, in our lifetime! That means that 12.5% of all women will get breast cancer at some point in their lives. Even more strikingly, this means that most of us know someone who has been diagnosed with breast cancer. In the statistical data released by cancer.net, deaths for women with breast cancer this year is estimated to reach 41, 760 in the United States. These are sobering statistics.
Breast Cancer in Women
In a recently published article, more than 3 million women have been diagnosed with breast cancer. Following lung cancer, in the United States, breast cancer is the second most common cause of cancer deaths for women. Fortunately, due to early detection, continued research and continued improvements in treatment options and strategy, the death rates (mortality) caused by this condition have steadily decreased since 1989.
However, with increased survival from the disease comes questions, as they relate to quality of life for those who are survivors. For those women who have been diagnosed during their reproductive years, the whirlwind of emotions related to their diagnosis, and survival following treatment, include questions about their future fertility and childbearing.
For most of us, because it is not usually broken down in this way, we assume that breast cancer is a diagnosis that only affects older women, after menopause, but when we do that we miss a critically important group of women; those under age 45! Eleven percent (11%) of breast cancer cases are in women younger than 45 years old. If this is the first time that you are learning this, I am not surprised. When coupled with the reality that many of the treatments for breast cancer can actually cause loss of eggs, and ultimately, infertility in women, it is critical that we discuss Breast cancer in younger women and make as many people aware of it, as possible.
For many women in the under 45 age group, news of their breast cancer diagnosis presents them with needing to make important and time-sensitive choices, about their future fertility, before they have to begin their cancer treatments. Additionally, even if their treatments may not include options that can cause loss of their eggs, most are then asked to wait 5 or 10 years after completing their treatments before attempting to conceive. In those patients (e.g a 35-year-old woman), a 5 or 10-year wait can mean the difference between being fertile or simply running out of eggs, due to normal aging and ovarian biology. This reality is part of what drives me to talk about this as often as possible and with as many people, as are willing to hear it.
For most of you who are reading this article, you have heard over and over about the importance of mammograms, breast exams and why early detection of breast cancer saves lives, in women but here is a quick review:
How can a woman get screened for Breast Cancer? Breast cancer screening cannot prevent cancer but early detection can help you treat it before it spreads and therefore lowers your risks of dying from breast cancer. The best tool recommended for women, when screening for Breast cancer, is Mammography. Mammograms are the images produced by a specialized x-ray procedure of the breasts. This tool can detect breast cancer in women; even those without early symptoms. A Breast Magnetic Resonance Imaging (MRI) is sometimes used, along with mammograms, in certain women. MRIs use magnets and radio waves and are usually used for those who are already at high risk for developing breast cancer. A woman who wishes to get screened must always seek professional help, as their doctor can best determine the ideal screening option for their individual situation.
Which women seem to be at higher risk for developing Breast Cancer? As you age, the risk for breast cancer actually increases. In a study by the U.S Preventive Services Task Force or USPSTF, women who are 50 to 74 years old are at higher or average risk for breast cancer. Thus, they are required to have a mammogram every one to two years. Those who are 40-49 years old are also recommended to have regular mammograms by the American College of Obstetrics and Gynecology. If you are unsure about whether you need a mammogram, you should talk to your health care provider.
Lastly, in certain families, risk of breast cancer is higher than the 1 in 8 number that I quoted above because of the presence of the Breast cancer gene in the family. For someone who has this increased risk, the age of screening for breast cancer begins as early as in your twenties…10 years before the age of diagnosis of your youngest first degree relative with breast cancer. For example, this means that if your mother or sister were diagnosed with breast cancer at age 35, then you will need to start screening at age 25.
So, what needs to be considered once a woman is diagnosed with breast cancer; especially when she is under age 45? Right after she receives the breast cancer diagnosis, the next discussion is treatment. For most women, this includes surgery and/or one of the following:
- Chemotherapy – Chemo is a known treatment for cancer that uses drugs to target and kills cancer cells, quickly. Because it is generally given via an intravenous route, chemo circulates throughout the whole body and is most likely to affect not only the cancer cells but also other healthy cells such as a woman’s eggs. As a result, specific forms of chemotherapy can significantly increase the chances for women to develop premature ovarian failure or go into early menopause. This is especially concerning for women in their 30’s and older who have a smaller pool of eggs in their ovaries but maybe, still wish to start or grow their family
- Radiation Therapy – Although it does not usually impose direct risks on fertility for women undergoing this form of treatment for breast cancer, this procedure uses high energy rays or radioactive substances which can kill cancer cells by interfering with their growth and division. If for any reason, this form of therapy needs to be targeted to her pelvic organs, it can cause damage to a woman’s ovaries; leading to loss of her eggs and maybe even damage to her womb (uterus) and her ability to carry a baby.
- Hormonal Therapies – Women with tumors which have proteins on them that can bind to hormones (known as hormone receptor-positive tumors) are most likely recommended to go through hormonal therapy. These therapies are often used before or after surgery to help shrink the tumors and are known as adjuvant therapy; which usually reduces the risk of the cancer cells growing or returning. However, while some women are still considered potentially fertile during these therapies, and most get a period during and after the treatment, the time it takes for a woman to complete this therapy (5 to 10 years) usually leads to loss or significant decrease of her natural fertility due to loss of eggs in her ovaries, which comes naturally with aging.
Breast Cancer in Men?
Contrary to popular belief, men get breast cancer too! Yes, breast cancer does not just affect women. In fact, it is estimated that about 500 men died, as a result of breast cancer, in the United States, for this year alone. Compared to women, breast cancer in men is actually rare; with less than 1% (1 in 1000 men) being diagnosed. Breast cancer in men is gaining more notice in the media due to recent cases of men such as Mathew Knowles, father of Beyonce and Solange Knowles and Actor Richard Roundtree who is famous for the Shaft movies.
The sad thing is, men are said to have lower breast cancer survival rates than women and this is likely due to them being diagnosed later i.e. when the cancer is more advanced. In addition, the treatment of breast cancer in men can lead to infertility, just as how it is for women.
While diagnosis and treatment of Breast Cancer in men is similar to the process for women, it is highly recommended that any man with Breast Cancer get genetic testing to see if he is a carrier for the Breast Cancer gene (e.g BRCA). This is important to do because if he has a daughter who inherits the gene, she has an up to 80% chance of developing breast cancer and up to 40% chance of developing ovarian cancer. In addition, he and his sons, if they inherit the gene, are at risk for developing prostate cancer at a young age.
How can a guy get screened for Breast Cancer? Firstly, he or his healthcare provider should do a breast exam. Specifically, if you feel a hard lump or growth underneath the nipple or areola, you should get it checked out, ASAP. Men carry higher mortality, from Breast Cancer, than women do, because awareness among men is less and they are less likely to assume a lump is Breast Cancer, which can cause a delay in seeking treatment.
Which men seem to be at higher risk for developing Breast Cancer? Those with first-degree relatives (Dad, Mom, Brother, Sister) who had Breast Cancer, those with a history of exposure to radiation or those exposed to prolonged and high levels of estrogen hormone.
How does Cancer Treatment Affect Men? A man undergoing cancer treatment is at risk for having disruptions in his reproductive processes which can then lead to him experiencing losses in his fertility due to decreases in his ability to ejaculate, produce hormones, and even produce healthy sperm. As a matter of fact, when it comes to certain types of chemotherapy, some men may become permanently sterile and never make sperm again.
Oncofertility: What Is It and How Can It Help?
By now, you are probably asking if anything can be done to help those younger people who are diagnosed with cancer but also would like to extend their chances of building a family after their cancer is treated. That is where the field of Oncofertility comes in! Oncofertility is a specialized area of Fertility medicine that is focused on helping young patients who are diagnosed with cancer to preserve their chances of having biological children once they’ve completed their life-saving surgery, chemotherapy, radiation therapy or combination therapy.
An Oncofertility specialist works closely with the patient and their cancer doctor(s) to cryopreserve or freeze their eggs, or embryos if they have access to sperm, while keeping their circulating estrogen hormone levels low enough so as not to cause cancer to grow and all the while, not delaying the start of their cancer treatment.
Those patients who produce semen are also able to freeze sperm which can be used later for helping to conceive. Oncofertility, therefore, maximizes the reproductive potential of cancer patients and survivors.
There are many options to preserve fertility. These options include shielding the ovaries or testicles during radiation therapy to the pelvis, ovarian transposition (surgically lifting the ovaries out of the radiation area), egg banking (freezing eggs), Embryo Banking (freezing fertilized eggs) or Sperm Banking (freezing sperm). These options are all FDA approved standards of care and are not experimental forms of therapy. There is also Tissue Banking (freezing parts of the ovaries or testicles) but that is only available at limited institutions and for select types of patients. For one to know the best fertility-preserving option for their cancer status, it is highly recommended that these patients consult with their local reproductive endocrinologists after the diagnosis of cancer, and prior to any treatment.
Dr. Cindy Duke: An Oncofertility Specialist
As an Oncofertility specialist, I am proud to state that my clinic, Nevada Fertility Institute, offers year-round egg/embryo/sperm freezing services, without delay, for cancer patients. While this blog focuses on Breast Cancer, as an Oncofertility specialist, I work with patients with a variety of cancers and who range in age from their teens to their early forties.
I have to admit that there can, unfortunately, be cost constraints associated with egg/embryo freezing. Some studies have suggested that women with cancer and those who either have one child or are not married, are less likely to be given information about preserving their fertility. Moreover, other studies suggest that those of lower socioeconomic brackets are also less likely to be counseled about fertility preservation, due to their perceived inability to afford these services. A significant portion of the cost for fertility preservation is related to the medications which are used. I always remain mindful of this reality and I am proud to say that my clinic & I have partnered with LIVESTRONG Foundation to provide qualified patients with medications at minimal to no cost, all-year-round!
Additionally, a big part of my work, as an Oncofertility specialist, is my advocacy and efforts to raise awareness about this area of reproductive medicine and the services that we provide. I especially work within the community with Governmental and Nongovernmental organizations, foundations, hospitals, places of worship, universities and medical schools to spread the word, break down misconceptions about the affordability of these treatments and emphasize the readily available access for these services in our community and across the country. I also dedicate a lot of time to sharing the recommendations of the American Society of Clinical Oncologists and the American Society for Reproductive Medicine’s that all patients of reproductive age, who are facing a cancer diagnosis, be offered counseling on the potential impact of their cancer treatment to their future fertility. In addition, I put the triple effort into helping people understand how Oncofertility works and how having this service as an available option, for young cancer patients, helps to give hope for future quality of life to a survivor and their family, via my very active social media presence. Through advocacy like mine, some oncofertility specialists have succeeded in getting their state legislators to provide health insurance coverage for oncofertility services in their states.
While receiving a cancer diagnosis can be a shocking and dramatic transformation of one’s reality, it is important that we all know the options that are available to us no matter of gender, race or class. I have had patients come to see me after being told of their options for fertility preservation by a grandparent, a family friend or a member of their church, who happened to hear one of my talks on Oncofertility. It is this that drives me to continue to advocate on this subject!
If you or someone you know would like to hear more about oncofertility or would like to have me present to your institution, group, church or community, please do not hesitate to reach out!