Abstract
Malignancy may unfortunately present quite early in a woman’s life. In the case of breast cancer, rescue of the breast cancer patient’s life is the top priority, but after completion of the effective treatment , the question about the ability to accomplish a pregnancy arises. The treatment strategies in breast cancer patients include surgical interventions, chemotherapy , radiotherapy, hormonal therapy and other special types of mainly targeted biologic therapies. Under normal circumstances, surgery for breast cancer does not involve any intervention in the ovaries or the uterus. Thus, even after an extended operation, the anatomic integrity of the gynecological system is guaranteed, and fertility is unaffected.
The chemotherapeutic factors that influence fertility are the drug category used, the total dose given, the patient’s age at treatment , the drug combination and finally whether targeted therapy is used or not. Alkylating agents are considered to be the most toxic ones. In young breast cancer patients there is a trend to modify regimens to achieve less gonadotoxicity.
Evidence regarding tamoxifen, the main used endocrine drug, is scarce and controversial on its direct effect on ovarian reserve. There are not enough studies on the impact of aromatase inhibitors on fertility. Also, HER2-directed agents have not yet demonstrated significant ovarian toxicity and there are scarce data on their effect on fertility.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. Cancer J Clin 65(1):5–29
Anders CK, Johnson R, Litton J, Phillips M, Bleyer A (2009) Breast cancer before age 40 years. Semin Oncol 36:237–249
Howlader N, Noone AM, Krapcho M eds (2014), SEER Cancer Statistics Review, 1975–2011. National Cancer Institute: Bethesda. Based on November 2013 SEER data submission, posted to the SEER website, April 2014
Tarlatzis B, Zepiridis L (2003) Perimenopausal conception. Ann N Y Acad Sci 997(1):93–104
Broekmans FJ, Faddy MJ, Scheffer G, te Velde ER (2004) Antral follicle counts are related to age at natural fertility loss and age at menopause. Menopause 11:607–614
Meirow D, Nugent D (2001) The effects of radiotherapy and chemotherapy on female reproduction. Hum Reprod Update 7(6):535–543
Warne GL, Fairley KF, Hobbs JB, Martin FI (1973) Cyclophosphamide-induced ovarian failure. New Engl J Med 289(22):1159–1162
Su HI, Sammel MD, Green J, Velders L, Stankiewicz C, Matro J et al (2010) Antimullerian hormone and inhibin B are hormone measures of ovarian function in late reproductive-aged breast cancer survivors. Cancer 116(3):592–599
Goodwin PJ, Ennis M, Pritchard KI, Trudeau M, Hood N (1999) Risk of menopause during the first year after breast cancer diagnosis. J Clin Oncol 17(8):2365–2369
Minton SE, Munster PN (2002) Chemotherapy-induced amenorrhea and fertility in women undergoing adjuvant treatment for breast cancer. Cancer Control 9(6):466–472
Morarji K, McArdle O, Hui K, Gingras-Hill G, Ahmed S, Greenblatt EM et al (2017) Ovarian function after chemotherapy in young breast cancer survivors. Curr Oncol 24(6):e494–e502
Peigne M, Decanter C (2014) Serum AMH level as a marker of acute and long-term effects of chemotherapy on the ovarian follicular content: a systematic review. Reprod Biol Endocrinol 12(1):26
Nagarajan R, Robison LL (2005) Pregnancy outcomes in survivors of childhood cancer. J Natl Cancer Inst Monogr 2005(34):72–76
Meirow D (1999) Ovarian injury and modern options to preserve fertility in female cancer patients treated with high dose radio-chemotherapy for hemato-oncological neoplasias and other cancers. Leuk Lymphoma 33(1-2):65–76
Ronn R, Holzer HE (2013) Oncofertility in Canada: the impact of cancer on fertility. Curr Oncol 20(4):e338–e344
Turan V, Oktay K (2014) Sexual and fertility adverse effects associated with chemotherapy treatment in women. Expert Opin Drug Saf 13(6):775–783
Crozier JA, Swaika A, Moreno-Aspitia A (2014) Adjuvant chemotherapy in breast cancer: to use or not to use, the anthracyclines. World J Clin Oncol 5(3):529–538
Jensen JR, Morbeck DE, Coddigton CC (2011) Fertility preservation. Mayo Clin Proc 86(1):45–49
Sonmezer M, Oktay K (2004) Fertility preservation in female patients. Hum Reprod Update 10(3):251–266
Pierce LJ, Strawderman M, Narod SA, Oliviotto I, Eisen A, Dawson L et al (2000) Effect of radiotherapy after breast-conserving treatment in women with breast cancer and germline BRCA1/2 mutations. J Clin Oncol 18(19):3360–3369
Hickey M, Peate M, Saunders CM, Friedlander M (2009) Breast cancer in young women and its impact on reproductive function. Hum Reprod Update 15(3):323–329
Hawkins MM, Smith RA (1989) Pregnancy outcomes in childhood cancer survivors: probable effects of abdominal irradiation. Int J Cancer 43(3):399–402
Lee SJ, Schover LR, Partridge AH, Patrizio P, Wallace WH, Hagerty K et al (2006) American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol 24(18):2917–2931
Critchley HO, Bath LE, Wallace WH (2002) Radiation damage to the uterus-review of the effects of treatment of childhood cancer. Hum Fertil 5(2):61–66
Partridge AH, Ruddy KJ, Gelber S, Schapira L, Abusief M, Meyer M et al (2010) Ovarian reserve in women who remain premenopausal after chemotherapy for early stage breast cancer. Fertil Steril 94(2):638–644
Torino F, Barnabei A, De Vecchis L, Sini V, Schittulli F, Marchetti P et al (2014) Chemotherapy-induced ovarian toxicity in patients affected by endocrine-responsive early breast cancer. Crit Rev Oncol Hematol 89(1):27–42
American College of Obstetricians and Gynecologists (2014) Committee Opinion No. 601: tamoxifen and uterine cancer. Obstet Gynecol 123(6):1394–1397
Azim AA, Costantini-Ferrando M, Oktay K (2008) Safety of fertility preservation by ovarian stimulation with letrozole and gonadotropins in patients with breast cancer: a prospective controlled study. J Clin Oncol 26(16):2630–2635
Zagouri F, Sergentanis TN, Chrysikos D, Papadimitriou CA, Dimopoulos MA, Bartsch R (2013) Trastuzumab administration during pregnancy: a systematic review and meta-analysis. Breast Cancer Res Treat 137(2):349–357
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Dinas, K.D. (2020). Impact of Breast Cancer Treatment on Fertility. In: Alipour, S., Omranipour, R. (eds) Diseases of the Breast during Pregnancy and Lactation. Advances in Experimental Medicine and Biology, vol 1252. Springer, Cham. https://doi.org/10.1007/978-3-030-41596-9_24
Download citation
DOI: https://doi.org/10.1007/978-3-030-41596-9_24
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-41595-2
Online ISBN: 978-3-030-41596-9
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)