Practical consensus recommendations on fertility preservation in patients with breast cancer

Abstract

Young women diagnosed with cancer today have a greater chance of long-term survival than ever before. Successful survivorship for this group of patients includes maintaining a high quality of life after a cancer diagnosis and treatment; however, lifesaving treatments such as chemotherapy, radiation, and surgery can impact survivors by impairing reproductive and endocrine health. Expert oncologists along with reproductive medicine specialists discuss fertility preservation options in this chapter since fertility preservation is becoming a priority for young women with breast cancer. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.

An investigation into the reproductive concerns of young women with breast cancer

“…14 Maternal affection can be a powerful force, with the mother's concern for her children's safety sometimes being much greater than that for herself. Prospective mothers naturally want to bear healthy children but measures such as chemotherapy and endocrine therapy can have teratogenic effects on reproductive cells 15 and lead to adverse effects in the fetus, which has been shown to cause high levels of concern in young women with breast cancer. Meanwhile, certain genetic factors in breast cancer can result in genetic mutations in a small number of patients, 16 whose children would be at a high risk of developing breast cancer.…”

“…During pregnancy, increased estrogen levels lead to the deterioration, recurrence, and metastasis of breast cancer, all of which work against recovery. 15 As a result, patients fear that becoming pregnant might increase the probability of a recurrence of the disease and that they might not be healthy enough to raise their children. Young patients usually undergo postoperative adjuvant chemotherapy, which is harmful to their reproductive organs and can cause harmful side effects such as premature ovarian failure and menopause, 15 and patients worry about not being able to have children as a result.…”

Ovarian tissue cryopreservation in a patient with breast cancer during pregnancy: a case report

“…It is an important measure to reduce the recurrence and prolong the survival of patients undergoing breast-conserving surgery and high-risk mastectomy [ 27 ]. In breast cancer patients receiving standard whole breast radiotherapy, 2.1–7.6 cGy (1Gy = 100 cGy) reaches the uterus and ovaries through the internal scattering of 50Gy radiation dose to the breast [ 28 ]. Radiotherapy is not recommended for PrBC but can be chosen according to the condition after stopping breastfeeding at the end of pregnancy [ 29 ].…”

A efetividade das técnicas de criopreservação na manutenção da fertilidade em pacientes oncológicas: uma revisão literária/ The effectiveness of cryopreservation techniques in maintaining fertility in oncologic patients: a literature review

“…Uma possível explicação é que o dano causado pelas drogas nos folículos primordiais geram um feedback hipofisário para gerar um novo pool de crescimento, mas como a maioria dos folículos primordiais humanos são inativos, a quimioterapia acaba afetando aqueles capazes de realizar divisão mitótica. Por outro lado, dados mostram que esses tratamentos não refletem nas taxas de neoplasias malignas e malformações congênitas em seus descendentes (Bajpai, 2018;Danis et al, 2017;Ter Welle-Butalid, 2019).…”

“…Para se estabelecer um comparativo entre as técnicas é necessário analisar tanto o processo de obtenção dos tecidos quanto a resposta desses aos métodos de congelamento, além disso também é necessário compreender as necessidades específicas da paciente e de seu tratamento (Quadro 1). (Bajpai, 2018;Rienzi, 2017…”