Most women have already reached menopause when they're diagnosed with breast cancer. However, breast cancer is still the most common cancer in women ages 15 to 39, according to the Young Survivor Coalition. For younger women, breast cancer comes with some different challenges. For example, many women in their teens, 20s, and 30s worry about their future fertility.
If you've been diagnosed with breast cancer but may want to have a baby later, be sure to bring up the topic with your care team. Here are some ways your cancer may affect fertility and the proactive steps you can take.
How breast cancer treatment affects fertility
Chemotherapy targets fast-diving cells like those found in cancer. However, there's a risk some chemo drugs might affect other rapidly diving cells, such as those in your ovaries, too.
If chemo causes damage to your ovaries, it can cause early menopause and a loss of fertility. The American College of Obstetricians and Gynecologists says this loss of fertility may be permanent, or it may mean it is harder - but not impossible - for you to get pregnant in the future.
Radiation may also cause problems with ovarian function. If your radiation treatments are targeted at your breast tissue, the effects on your ovaries may be less of a concern. The risks of fertility side effects increase when radiation targets the pelvic area.
Depending on the type of breast cancer, you may also take hormone therapy, such as Tamoxifen, in the years following your treatment. This therapy works to reduce the chance of breast cancer coming back. But it isn't safe for you to get pregnant while you're taking it.
Talking with a fertility specialist
The first step to navigating your fertility and breast cancer is to visit with a specialist. Talk to an OB GYN who is board-certified in reproductive endocrinology and infertility to find out your options. The sooner you meet with a fertility specialist after your diagnosis, the better. You'll want your specialist to be a part of your care planning from the start.
Egg and embryo freezing
Many women choose egg or embryo freezing before starting breast cancer treatment to preserve fertility. In both cases, you'll take certain fertility medications for a couple weeks to stimulate your ovaries to release more eggs. Then, your fertility specialist will carefully retrieve the eggs. Some women choose to freeze and store unfertilized eggs. If you have a partner, the eggs may also be fertilized in the lab to create embryos before freezing.
Some studies have shown benefits to ovarian suppression during chemo treatments. Because chemo targets cells that are dividing, ovarian suppression temporarily shuts down this process in the ovaries to protect them. While still being studied, the Susan G. Komen Foundation says drugs such as goserelin, leuprolide, and triptorelin may help lower the chance of going into early menopause due to chemo.
Ovarian tissue preservation
Research has also studied the use of ovarian tissue preservation as an option. But the American Society of Clinical Oncology says this option is still being evaluated. With tissue preservation, ovarian tissue is surgically removed before treatment and frozen. Then, after treatment, the tissue is retransplanted.
Pregnancy after breast cancer
It's common for breast cancer survivors to ask how pregnancy may affect their chances of breast cancer happening again. However, a study in Oncology showed women who got pregnant after breast cancer didn't have a higher chance of cancer coming back than those who did not have a pregnancy.
Every woman has a different timeline for recovery. And your team may recommend you wait before trying to conceive. After you finish treatment, your fertility specialist and your cancer care team can guide your decisions about pregnancy. Even if your fertility was affected by treatment, they can help you understand your many options to start a family.