Aprajita, a 35-year-old woman, was diagnosed with stage II hormone receptor-positive breast cancer when she was just 27 years old. The oncologists had advised a partial mastectomy followed by hormonal therapy for the next five years. Since she was newly married when the cancer diagnosis happened, she checked with the oncologists on the effects of therapy on her fertility. She was advised to consult a fertility specialist, who recommended that she preserve her embryos or oocytes before the cancer treatment began.
Breast cancer has become significantly prevalent among many young women in the country today, as the detection rates are going up due to robust treatment. At the same time with improvement in cancer management, the survival rates are also on the rise. Although there is no particular cause for developing breast cancer, unhealthy lifestyle, excessive consumption of alcohol, family history of breast cancer, etc. are some of the risk factors that can increase the chances of getting the disease.
The Indian Council of Medical Research (ICMR), in one of its studies, stated that in the year 2016, the total number of cancer cases is expected to be 14.5 lakh and the figure is likely to reach nearly 17.3 lakh new cases in 2020. It is estimated that around 1.5 lakh new cases of breast cancer are diagnosed in 2016, which is ten per cent of all types of cancer cases in the country.
Breast cancer may not directly affect the fertility of a woman. However, the treatments of breast cancer such as chemotherapy, radiotherapy, hormonal therapy, etc. do have adverse effects on women’s fertility. When a woman is first diagnosed with breast cancer, it is essential for her to be educated about how her fertility can be affected during the treatment process, especially if she is young and in her childbearing years.
Chemotherapy and radiotherapy work by acting against fast dividing cells of the body. This helps control or stop the cancer cells proliferation, but this treatment can also effect the normal dividing cells of the body and can cause damage to the gametes i.e. eggs and sperms, which are the dividing cells. This can lead to depletion of cells, and hence effect fertility. Women are born with a finite number of eggs and in some, the treatment with chemotherapy and radiotherapy may lead to complete or partial loss of fertility potential.
Fertility preservation is an effort to help individuals retain their fertility or ability to procreate. Onco-fertility bridges the specialties of oncology and reproductive endocrinology with the purpose of maximizing the reproductive potential of cancer patients and survivors. It comes across as a way to cope with the uncertainty of experiencing pregnancy and parenthood. Techniques such as egg freezing and embryo freezing can give hope to breast cancer patients who plan to conceive later.
Aprajita, who had luckily frozen her embryos, was able to conceive through in-vitro fertilization (IVF) after her five year hormonal therapy, which diminished her production of eggs. Today she is blessed with a beautiful baby girl. However, women who are unmarried have an option of preserving their oocytes prior to the chemotherapy and use those once they are declared disease free in the future to effect conception. Women who had discussion about fertility prior to receiving cancer treatment were at less risk of developing psychological issues post completion of cancer treatment and also were found to have better quality of life. The worldwide uptake of oocyte or embryo freezing among cancer patients is at about 10%. There is an increasing awareness among cancer patients and the oncology community regarding fertility preservation.
Not every cancer patient will have the opportunity to preserve their fertility before chemotherapy or radiation treatment. There are many instances where it becomes too late for a cancer patient to take the decision of preserving the oocytes or embryos. For those not fortunate to have frozen eggs or embryos prior to cancer treatment and whose gametes have been completely depleted, in-vitro fertilization with donor eggs is a common solution. Egg donation is often a successful treatment for infertility in women who can no longer produce healthy eggs. The entire process of donating eggs, fertilizing them with sperm and implantation usually takes 6 to 8 weeks per cycle.
Cancer is a disease wherein the stage of detection can decide the fate of the patient. Early detection can help prevent serious complications and recover faster than when it is diagnosed at a later stage. Keeping a check on the body, maintaining a healthy diet, avoiding excessive alcohol intake and consulting the doctor in case of any abnormalities in the body can go a long way in fighting cancer. Awareness of and access to existing advanced technologies are important for patients who will be undergoing chemotherapy and radiotherapy, even for non-cancerous diseases.