Advancements in cancer treatment throughout the past decades
have significantly improved survival rates. Consequently,
longterm physical and psychological side effects are becoming
increasingly popular topics of cancer research. Impaired
fertility is a longterm side effect experienced by many
cancer patients treated before or during childbearing years,
including survivors of gynecological and genitourinary malignancies,
breast cancer, and other solid tumors and hematologic malignancies.
The actual incidence of impaired fertility
associated with cancer and its treatments is not well documented.
However, approximately 1 in 51 women and 1 in 71 men are
expected to develop cancer by the age of 39, and more than
130,000 cancer patients—approximately 10% of the cancer
population—are diagnosed in their reproductive years
(American Cancer Society, 2001; Fertile Hope, 2005; Schover,
2004). For instance, approximately one fourth of all breast
cancer patients are diagnosed prior to menopause, and between
10% and 20% of all breast cancer patients are of childbearing
age (Parker, Tong, Bolden, & Wingo, 1997). Additionally,
in the United States, 1 out of 900 persons aged 15 to 44
are survivors of childhood or adolescent cancer (American
Cancer Society, 2002), the treatment of which can have lasting
effects on fertility. Moreover, 12,400 children and adolescents
(< 1 year to 19 years of age) are diagnosed with cancer
each year in the United States (National Cancer Institute
SEER Program, 1995).
The majority of women diagnosed with cancer
live more than 10 years after diagnosis (Bauer, 2003), and
many are diagnosed at a time when fertility and family planning
are a major focus in their lives (Partridge & Winer,
2005). Bauer (2003) examined the prevalence of infertility
in female cancer survivors aged 18 to 50. Findings of the
study demonstrated that 77% of the women had permanentmenopause
due to cancer treatment. Fifty percent had cessation of
menses during cancer therapy, and for 78% of these women
menses never returned. Early menopause is also of great
concern for female survivors of childhood cancer. In studies
of women treated for cancer before the age of 20, 42% of
those treated with radiotherapy and chemotherapy reached
menopause by the age of 31, compared to 5% of the control
group (Wallace, Anderson, & Irvine, 2005). Moreover,
women who undergo chemotherapy or pelvic radiation during
their reproductive years have a 40% to 80% chance of infertility
(Fertile Hope, 2005). Additional studies show that fertility
in cancer survivors averages about 85% of that of their
siblings, with male fertility impacted slightly more than
female fertility by cancer treatment (American Cancer Society,
2002).
Many cancer survivors are left with significant
anxiety and insufficient information about reproductive
issues ( Schover, Rybicki, Martin, & Bringelsen, 1999).
The effect of cancer treatment on fertility is underaddressed,
mostly due to the lack of information provided by healthcare
professionals to cancer patients. To help bridge this information
gap, this newsletter will discuss fertility options available
to men and women diagnosed with cancer, with a special focus
on fertility considerations for female breast cancer survivors.
|
