One in 19 Malaysians will be diagnosed with breast cancer in their lifetime. 15% of these women are below 40. Early detection, often through regular breast self-examination, is crucial because when the cancer is in the localised stage, the five-year relative survival rate is 99%.
With new treatments and research today, more than 80% of breast cancer patients below the age of 40 will survive their diagnosis. When life returns to normal, once they are in remission, it is still possible for these women to start or complete their family.
Breast cancer does not cause infertility, but the treatment for it can. Conventional chemotherapy can damage the ovaries in 40% to 80% of women, causing a reduction in the number and quality of eggs and may cause premature ovarian insufficiency or early menopause.
“There are ways to help women preserve their fertility and it is important that they know the options available to them, ideally at the point of diagnosis,” says Dr Hoo Mei Lin, consultant gynaecologist and fertility specialist at Sunway Fertility Centre.
“Preserving fertility is often an afterthought when a woman is diagnosed with cancer because the focus is on treating cancer. With the advancement of medical technology, surviving a cancer diagnosis is becoming increasingly common. It is important to initiate the conversation with your doctor as there are ways we can help preserve your fertility,” she continues.
Doctors recommend that fertility preservation be done prior to any chemotherapy.
Preserving a man’s fertility is straightforward; semen is collected, frozen and stored for future use.
Women can opt to use chemotherapy drugs that cause less damage to the ovaries; or other methods that can be utilised to protect the ovaries prior to chemotherapy. They may also choose to freeze eggs or embryos (fertilised eggs), before cancer treatment begins. Pre-pubescent girls may decide to have their ovarian tissue harvested and frozen. When they want to have children, this tissue is thawed and transplanted into their body. The potential eggs will be stimulated using hormones, and harvested when mature.
“It may still be possible to conceive after surviving cancer. Women with breast cancer, even after chemotherapy, can go on to have kids naturally and breastfeed. Although surgery and radiation may damage breast tissue, breast cancer survivors may still able to breastfeed their children.
I would encourage cancer survivors to see a fertility specialist and have their fertility potential assessed,” she adds.
According to Dr Hoo, breast cancer does not impact the health of the baby, there is no increased risk of birth defects or long-term health concerns. Only 5% of breast cancer is inherited through specific genetic mutations and there is a 50% chance of a woman with such mutations passing them on to her children. Even if the children inherit the gene, it does not mean they will get breast and ovarian cancer; the risk of that is only increased.
Before embarking on pregnancy, it is recommended that a discussion be had with the doctors caring for you, your gynaecologist, your oncologist or cancer specialist. This is to ensure the best possible outcome for your pregnancy, your health and your baby.
“When someone gets a cancer diagnosis, she will be thinking: ‘How will I get over this? What am I going to do with my job, my finances? Let me get my will ready.’ She is already thinking about her future. By raising awareness about fertility in the face of cancer, Dr Hoo hopes that preserving one’s ability to have children in the future is taken into consideration early and that conversations are initiated not as an afterthought but as part of the treatment plans for cancer.