TUESDAY, Dec. 22 2015 Chemotherapy can affect a young breast cancer patient’s fertility, sending her into premature menopause, so in many cases doctors provide patients with hormonal therapy during chemo to prevent this side effect.
Now, new research suggests that the approach does help these patients without lowering their odds of surviving the cancer.
One expert noted that the issue is a tough one for many young breast cancer patients.
“The most reliable way in 2015 to preserve a patient’s fertility is through egg harvesting prior to chemotherapy and in vitro fertilization,” explained Dr. Charles Shapiro, director of translational breast cancer research at Mount Sinai Medical Center in New York City.
“However, as this procedure is typically not covered by insurance, it is only an option for those of financial means,” he said. “So, those who cannot afford the procedure can choose to receive [hormonal therapy] as it is has higher — but modest — rate of preserving menstrual function and possibly having subsequent pregnancy.”
The new study was led by Dr. Lucia Del Mastro of the National Institute for Cancer Research in Genoa, Italy. It included 281 women, median age 39, with stage 1 to 3 breast cancer who were randomly selected to receive chemotherapy only or chemotherapy plus the hormone drug triptorelin.
Over five years of follow-up, normal menstruation resumed in 73 percent of those in the hormone treatment group and 64 percent of those in the control group, the Italian team reported Dec. 22 in the Journal of the American Medical Association.
Pregnancy rates were 2.1 percent in the treatment group and 1.6 percent in the control group.
Survival didn’t seem to be affected: Five-year cancer-free survival rates were 80.5 percent in the hormone treatment group and 84 percent in the control group — not a statistically significant gap, the researchers said.
Dr. Lauren Cassell is chief of breast surgery at Lenox Hill Hospital in New York City. She noted that the study was well-designed, being prospective in nature and including a wide range of breast tumors that were either sensitive to estrogen or not.
“Our young women who continue to live long and happy lives are concerned about quality-of-life issues, which include the ability to bear a child as well as the negative effects of premature menopause,” Cassell said. She believes that a discussion of these issues, and potential solutions, is vital to breast cancer care.
But Shapiro believes those discussions aren’t happening often enough.
“Only about one-third of medical oncologists’ medical records document a discussion about risks of infertility,” he said, “and about one-fourth of these medical records discussed options or referred to [fertility] specialists. We have to do better.”
The U.S. Office on Women’s Health has more about premature menopause.