Breast Cancer and Fertility
Three things can potentially affect fertility in people who have breast cancer: the type of cancer treatment used, the type and stage of your cancer when it is diagnosed, and your age.
Type of Cancer Treatment Used
Different methods are used to treat cancer. However, not all of them affect fertility. Radiation and hormonal therapy affect fertility to a lesser degree, while chemotherapy can damage the ovaries and have a bigger impact on your fertility.
Chemotherapy works by killing cells in the body that are dividing quickly. The hormones, such as estrogen, needed to release eggs each month and prepare the uterus for a possible pregnancy are made in the cells of the ovaries called oocytes. Oocytes tend to divide quickly, so are often affected by chemotherapy.
Chemotherapy can therefore lead to loss of those important hormones and affect fertility. Sometimes a woman undergoing chemotherapy treatment will go into early menopause.
Chemo drugs that are linked to the risk of infertility in females are:
CarboplatinCyclophosphamideDoxorubicin
Higher doses of these drugs are more likely to cause permanent fertility changes, and combinations of drugs can have greater effects.
Stage and Type of Cancer
Being diagnosed with cancer doesn’t necessarily mean that you need chemotherapy. It all depends on the type of cancer and the stage it’s in when you’re diagnosed.
If your cancer is more advanced, chemotherapy will most likely be recommended, which may affect your ovaries and therefore fertility. Minor tumors with small nodes that are not as likely to spread are treated differently.
Some breast cancers are treated with hormonal drugs. According to the American Cancer Society, two out of every three breast cancer cases are hormone-sensitive. However, for cases that aren’t, you’ll have no other choice but to accept chemotherapy.
Patient’s Age
The younger you are, the more eggs you usually have in your ovaries. This gives you a higher chance to preserve some fertility despite damage caused by treatments like chemotherapy. Women who are treated for cancer before they turn 35 have the best chance of becoming pregnant after treatment.
Breast Cancer and Gestation
One study examined children who were exposed to chemotherapy in the uterus, and they didn’t have cancer.
If you are diagnosed with breast cancer while you are pregnant, some treatment options will have to be postponed until after delivery. This is to avoid complications like miscarriage or anything that will affect full-term delivery.
The kind of treatment your doctor will recommend for you will depend greatly on the stage of your cancer. Your doctor will consider:
The rate of the cancer cell growthThe number and size of tumorsThe exact type of breast cancerYour overall wellnessThe duration of your pregnancy
Surgery
The most common treatment option for breast cancer is surgery. There are two kinds: lumpectomy and mastectomy (breast tissue removal).
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Some experts say that breast surgery at the early stage of breast cancer is fine, but general anesthesia may pose some risk to your baby.
Chemotherapy
Research has shown that it’s safe to use chemotherapy during therapy from the second trimester. This is why your doctor may most likely not advise chemotherapy during your first trimester of pregnancy.
However, chemo drugs aren’t administered in the last three weeks of pregnancy. In some cases, waiting until you deliver is the best option.
Radiation
Your oncologist may discourage radiation therapy since high doses of radiation at any point of your pregnancy can potentially harm your baby.
The risks associated with radiation therapy during pregnancy include:
Cancer, especially during childhoodSlow fetal growthBirth abnormalitiesMiscarriage
Hormone and Targeted Therapies
Hormone therapies and targeted therapies like aromatase inhibitors aren’t advised for use during pregnancy. Some hormone therapy drugs, such as tamoxifen, can cause birth defects.
Targeted therapy drugs attack cancer cells differently from standard chemo drugs. Little is known about their effects on fertility or problems during pregnancy. However, what’s known is that some targeted drugs (thalidomide and lenalidomide) have such a high danger of causing birth defects that women are asked to use two effective types of birth control while taking them.
Other therapies you should avoid are:
PalbociclibTamoxifenTrastuzumabBevacizumabEverolimusLapatinib
Breast Cancer and Postpartum
You may experience some challenges while breastfeeding your child after surgery or radiation therapy.
One study showed a reduction in milk production in people who had breast cancer. These structural changes increased sensitivity in the breast and made it difficult for the baby to breastfeed. Nevertheless, a sizable amount of women in the study were able to breastfeed.
If you underwent hormone therapy and were placed on medications, consult your doctor before trying to breastfeed. Some drugs can be passed on to your baby through the breast milk when they breastfeed and affect them.
Summary
Some forms of breast cancer treatment like chemotherapy can potentially affect your ability to conceive and have a healthy baby. Other treatments like hormonal therapy may not affect your fertility, but they can lead to birth defects. If you have breast cancer and are pregnant or want to get pregnant, talk to your doctor about your treatment plan and how you can increase your chances of not only conceiving but also having a healthy baby.
How do you diagnose breast cancer in a pregnant person?
Signs like tender breasts and swelling make it quite challenging to diagnose breast cancer in pregnant people. You may need to check for other signs like dimpling of the skin, bloody discharge from the nipple, scaly breast skin, or any uncommon thickening in any part of the breast.
How do pregnancy and HRT influence breast cancer risk?
Hormone replacement therapy (HRT) increases estrogen levels, and higher levels of estrogen can stimulate cell growth. This may help breast cancer cells grow, resulting in a higher breast cancer risk. Similarly, women are exposed to higher levels of hormones like estrogen and progesterone during pregnancy, which increases their breast cancer risk.
How does pregnancy and lactation change breast tissue?
During pregnancy and lactation, your breast tissue continues to grow and your milk-producing cells get bigger. Sometimes you may experience pain due to these developments in your breast. Your body will also experience a rise in estrogen, progesterone, and prolactin, which increase the water, electrolyte, and fat content in your breast tissues.
How can breast cancer treatment affect someone who wants to get pregnant?
Chemotherapy and drugs like cyclophosphamide can negatively affect the ovaries and fertility. Other therapies like radiotherapy and hormonal therapy do not affect your fertility as much as chemotherapy does.
A Word From Verywell
Discovering that you have breast cancer especially during pregnancy, or coping with breast cancer while pregnant, can be devastating and stressful for you and your family. Treatment like chemotherapy can potentially harm both your chances of getting pregnant and your baby.
Consult your doctor to discuss the treatments you’ll need and what changes you need to make to your treatment plan. With the right interventions, you can still get pregnant and give birth to a healthy baby.
