Sarah Schellhorn, MD recently was a guest on the Yale Cancer Answers Connecticut Public Radio show with host Eric Winer, MD. He is director of the Yale Cancer Center and president and physician-in-chief of Smilow Cancer Hospital. The doctors, who are both breast cancer specialists, discussed cancer research findings and their implications for post-cancer fertility, pregnancy, and survivorship.
How do you approach conversations about fertility with breast cancer patients?
It's always a challenge when meeting a new patient diagnosed with breast cancer. It's important to discuss the cancer, treatment options, and reasons for recommendations. However, for younger women, it's crucial to consider if their family is complete, as treatments can affect future fertility. Chemotherapy, for instance, may induce menopause. It's age-related, so younger women might experience temporary menopause but can often regain fertility. We also discuss fertility preservation options like GnRH agonists during chemotherapy to protect ovarian function.
What are GnRH agonists, and how do they help preserve fertility during chemotherapy?
GnRH agonists are injections that put the ovaries into a dormant state, protecting them from the effects of chemotherapy. Studies show that women receiving these treatments during chemotherapy are more likely to have healthy pregnancies in the future.
What is the POSITIVE study, and what are its findings regarding pregnancy after breast cancer treatment?
The POSITIVE study looked at discontinuing endocrine therapy, like tamoxifen, earlier than the typical five years to allow women to achieve pregnancy. Results have been positive, showing that many women can have a healthy pregnancy and return to endocrine therapy with no detrimental effects on their cancer outcomes.
How have perceptions about pregnancy after breast cancer changed?
It was once assumed that pregnancy could stimulate cancer recurrence, but data does not support this. Advances allow for preserving fertility through various methods, including saving eggs or ovarian tissue, offering more options for women wanting to have children post-cancer treatment.
What fertility considerations are there for women over 42 with breast cancer?
At older ages, fertility options become more limited, and the likelihood of becoming pregnant naturally decreases. Often, treatments might suppress ovarian function or call for the use of medications such as tamoxifen, which should not be used during pregnancy.
How has breast cancer treatment evolved in recent years?
Treatment has become more personalized with tests like the Oncotype, allowing for tailored therapies and reducing unnecessary treatments. This approach improves patient outcomes and quality of life.
What is the Oncotype test?
The Oncotype test assesses the expression levels of 21 cancer-related genes in a tumor to predict benefits of chemotherapy and other treatment and likelihood of recurrence. Scores help determine whether a patient should receive chemotherapy.
What are the benefits of anti-hormonal treatments for breast cancer?
Anti-hormonal treatments like Tamoxifen and Aromatase inhibitors are used because over 75% of breast cancers are hormone-sensitive. These treatments reduce the chance of cancer recurrence significantly.
Can you describe the two most common anti-hormonal treatments?
Tamoxifen is a competitive antagonist of estrogen in the breast, reducing cancer recurrence by about 50%. Aromatase inhibitors reduce estrogen levels to nearly undetectable levels. Both have side effects, but they are crucial in preventing cancer recurrence.
What are the side effects of Tamoxifen?
Side effects include hot flashes, mood changes, and weight gain. Online forums often highlight these issues, but many women tolerate it well. Younger women might experience more symptoms due to their active ovarian function.
How do you decide if a patient should stay on Tamoxifen?
The decision is based on the absolute and relative benefits versus the side effects. If the risk of recurrence is low, the benefits might not outweigh the discomfort caused by side effects.
What is the outlook for women with breast cancer in terms of living a normal life post-treatment?
A large proportion – 80 to 85% go on and never hear back from this cancer, from their original cancer. And even women who do hear back from the cancer, whose cancer comes back whether in the breast or somewhere else, go on to live many, many years because of the advances in treatment.