Breast Cancer Awareness Month: What you need to know about its impact on pregnancy, fertility

Fertility and pregnancy-related issues are highly relevant for young patients with breast cancer (≤ 40 years). “Pregnancy-related cancers and pregnancy after breast cancer are both extremely relevant topics in India, where often we have women in their 30s and 40s developing breast cancer,” says Dr Niti Raizada, director, medical oncology and hemato-oncology, Fortis Group of Hospitals, Richmond Road, Bangalore.
According to the doctor, pregnancy-related breast cancer (BC) is diagnosed during pregnancy and within one year postpartum. “About 1 in 3,000 to 10,000 pregnancies are complicated with BC. When we evaluate cancer in pregnancy, both maternal and fetal well-being have to be  kept in mind. The cancer is similar to that seen in non-pregnant women, but more aggressive as there is delay in diagnosis due to concurrent breast changes,” she explains.

What does the treatment look like?
The doctor says the intent is to give “foetal-safe treatment” till the patient safely delivers the ba. “Surgery can be done and chemotherapy can be given in the second and third trimesters of pregnancy. But we avoid radiation, hormones and scans, which can harm the fetus,” she says.
Pregnancy after breast cancer
According to Dr Raizada, pregnancy after breast cancer is possible and is a part of cancer survivorship in young women. “Results provide reassuring evidence on the safety of conceiving in BC survivors. Patients’ pregnancy desire should always be considered as a crucial component of their survivorship care plan.”
Pregnancy-related breast cancer (BC) is diagnosed during pregnancy and within one year postpartum. (Photo: Getty/Thinkstock)
The doctor adds that BC survivors could have reduced likelihood of having a subsequent pregnancy compared with the general population due to various treatments and disease effects. There, however, is no increase in congenital abnormalities and maternal safety is not affected.
“The general practice is that pregnancy post BC treatment can be delayed around 2 years in stage I-II. For stage 3, deferring treatment for about 5 years is recommended and often avoided in stage 4. It is wise to take an individualised approach taking into account parameters including patient’s age, risk of recurrence, adjuvant therapy, and ovarian reserve,” says the expert.

Breast cancer and infertility
Infertility can arise as a consequence of treatment for oncological conditions, states the doctor. Chemotherapy can affect fertility drug or dose-related effect and age-dependent effect, she adds. “Radiation to the pelvis (dose dependent) can affect the ovaries and compromise fertility. Surgery in the pelvis can also comprise fertility.”
According to her, the methods usually recommended for fertility preservation in women prior to start of definitive anti-cancer therapy include:
* Embryo cryopreservation (well established treatment)* Ovarian tissue preservation* Ovum preservation* GNRH analogues to suppress ovarian cycle, thus inducing temporary menopause* Ovarian transposition (oophoropexy)
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