Defying all odds

CALL FOR HELP As breast cancer rates among young women is on the rise, their hope of motherhood seems grim, says Dr Jayanti S Thumsi, highlighting the

Cancer is a life-altering disorder, whether you have just been diagnosed or are in remission. Breast cancer accounts for 32% of cancers suffered by women in India. Currently, the incidence of breast cancer is on the rise at an alarming rate. But the most disturbing fact is that more and more young women are succumbing to this disease. Around 20% of women who develop breast cancer in our country are younger than 40.

The disease in younger women tends to be more aggressive and difficult to diagnose. In addition to this, younger breast cancer victims have problems like infertility and premature menopause.

Since the disease is aggressive in younger women, most of them are given chemotherapy. Many of them may also receive hormone treatment like administration of tamoxifen for five years or even 10 years. Chemotherapy and hormone therapy can and does affect a woman’s fertility.

Let’s take a look at the some of the side-effects of these treatments: Chemotherapy may damage some of the eggs in the ovaries and can cause irregular menstrual cycles or even stop them. This may give rise to fertility issues in some women. Chemotherapy attacks fast-growing cells. These not only include cancer cells, but also healthy ones in other parts of the body, like the ovaries.

Hormonal therapy can lead to irregular menstrual cycles, stop periods altogether, or make the ovaries stop producing eggs. With tamoxifen, periods can return after treatment ends. However, even in women whose periods normalise, treatment can shorten the window of time to have children.

Ovarian shutdown (which is done with medication and surgical removal of the ovaries) causes the body to stop releasing eggs each month and affects fertility. This infertility is permanent. Premenopausal women with early-stage breast cancer should at least wait about two years after diagnosis and treatment to get pregnant. This is because early-stage breast cancer has a high risk of relapse in the two years after diagnosis and treatment. Premenopausal women diagnosed with advanced-stage breast cancer usually undergo treatment longer than their diagnosis period. Because treatment may be ongoing, decisions about pregnancy are more complex for such women.

Some women can get pregnant naturally after their cancer treatment. But a few others find it hard. There are certain fertility preserving options for women who desire to get pregnant after breast cancer treatment.

IVF: At the moment, in-vitro fertilisation is the most effective way of preserving fertility. Before the onset of chemotherapy, hormones are injected in the body to stimulate the ovaries for the production of eggs. The eggs are removed and fertilised with sperm. If one doesn’t have a male partner at this stage, it is possible to use donor sperm. This creates an embryo, which can be frozen and stored and used at a later date when it is safe for the woman to get pregnant.

Egg freezing: It is now possible to extract women’s eggs and freeze them. This method is preferred if one does not have a male partner and doesn’t want to use a donor sperm. Ovarian tissue freezing: In this procedure, a small operation is performed to remove some ovarian tissue, which is then frozen. The tissue is put back once the cancer treatment is over.

Advanced treatments available for breast cancer have increased the survival rates in women. Today, there are several procedures that help women enjoy pregnancy after their battle with breast cancer.

(The author is a senior consultant Breast Oncology, BGS Gleneagles Global Hospital)