While Pregnancy May Be Possible After Chemo, How Many Patients’ Plans Change?

Young women with breast cancer who undergo treatment with chemotherapy recover normal menstrual cycles at a high rate and becoming pregnant is generally possible, according to a new study, but many women change their minds about the desire to become pregnant.

Because chemotherapy is known to have a negative impact on reproductive ability for young breast cancer patients, fertility preservation procedures are often used. In France, where the new study was conducted, these procedures require certain facilities, which can make it harder to access for some women. The French National Cancer Plan recommends the service be expanded across the country. “We wanted to find out whether the need and demand for it among breast cancer survivors was on a par with the level of investment and organization called for by the policymakers,” said Jérôme Martin-Babau from Centre Armoricain de Radiothérapie, Imagerie Médicale et Oncologie in Plérin, France, in a press release.

The researchers sent a survey to 96 breast cancer survivors between the ages of 18 and 40 who were treated with chemotherapy for nonmetastatic breast cancer, of whom 60 agreed to participate. The results were presented at the European Society for Medical Oncology (ESMO) 2018 Congress, held October 19–23 in Munich.

The median age at diagnosis was 36 years, and the median time between the end of their chemotherapy and participation in the study was 57 months. Most of the patients-83%-experienced amenorrhea, a complete absence of menstruation, during their chemotherapy treatment. Unexpectedly, 86% of those patients reported that their menstrual cycle returned to normal within 1 year after the end of chemotherapy treatment, indicating that the ovaries were not significantly damaged.

More than one-third of the cohort reported that they had plans to become pregnant before beginning the treatment. Only approximately 10% maintained the desire to become pregnant after chemotherapy. Of six patients who still wanted to have children, four became pregnant, though two of these ended in a miscarriage.

Martin-Babau noted that one-third of patients originally identified for the study did not respond, “possibly due to frustration with their personal situation.” Those patients could have changed the results, but the study still does suggest that natural pregnancy is feasible following chemotherapy treatment.

Matteo Lambertini, MD, of the Institut Jules Bordet in Brussels, who commented on the study, stressed that this shouldn’t change an important part of clinical practice when treating young women with breast cancer. “This does not mean that oncologists shouldn’t talk about fertility preservation measures with their patients, including in cases where their cancer center doesn’t offer fertility services onsite,” he said. “Indeed, the minority of women who are interested will gladly travel to the nearest facility that does.”

Lambertini added that pregnancy and reproductive issues remain important for this patient population. “As physicians, we must continue to discuss the potential loss of ovarian function and fertility with every one of our breast cancer patients, just like we would do with any other side effect of treatment: as early and as extensively as possible.”