Breast cancer isn’t common in women below the age of 35 but for those who are diagnosed with it there are complexities around fertility and pregnancy that need to be addressed

Only 7% of women under the age of 35 are diagnosed with breast cancer. It’s rare. It is also often more aggressive than cancer in older women and more advanced. This means that young women not only receive a diagnosis that is about to change their life, but they have to make serious decisions about their fertility far sooner than many of them expected.

“Fertility is a considerable factor among women in this age group,” says Dr Rika Pienaar, clinical and radiation oncologist, Cancercare. “Women of 35 years and younger have a 15% risk of going into permanent menopause after chemotherapy so it is essential that, if you are in this age group, you discuss your fertility status with a specialist as soon as possible.”

From the moment that the cancer is diagnosed, there is a whirlwind of tests, surgeries, medications and appointments. The onslaught of information is often overwhelming and Dr Pienaar advises that women take time to think about what they want and what they need before making any decisions.

“It’s so important that you talk about your fertility concerns and understand your options,” she says. “You need to talk about your fertility preservation before you hurry into chemotherapy. Two weeks extra won’t impact your outcome. You can opt to harvest your eggs, you can freeze your ovarian tissue or you can suppress ovary function throughout their treatment – none of these fertility preservation methods will affect your cancer treatment.”

Harvesting eggs is a common solution as the eggs can be frozen to be used once treatment is complete. However, it is a costly procedure that isn’t covered by medical aid and the success rate isn’t high. The average woman will get around eight to 16 eggs per R40,000 procedure. Another option is to preserve ovarian tissue by freezing it or to use medication that slows ovarian function down so much that it becomes less of a target for the chemotherapy.

The diagnosis of breast cancer is devastating for any woman but younger women have to face a deeper struggle. If they have young children they need to juggle parenting alongside their treatment. If they haven’t had children yet, or don’t have a long-term partner, they have to make decisions today that they had long thought would be made tomorrow.

“Young breast cancer patients need so much more support, both emotionally and medically,” says Dr Pienaar. “Oncologists haven’t been prepared to talk about fertility in the past as there was the issue of pregnancy after the diagnosis, but studies have shown that this won’t compromise your survival or your relapse rate.  Research found that pregnancy after an early diagnosis can improve the survival rate of women in this age group.”

The reality is that women need to understand exactly how chemotherapy is going to affect their health and their future. Chemotherapy will age the eggs by 10 years which will reduce fertility significantly and there is the risk of relapse within a five-year period.

“Only 5-10% of women have a normal pregnancy after being diagnosed with breast cancer,” concludes Dr Pienaar. “It is so important that you are given choices about how you will plan for your future and your fertility. Speak to specialists and your oncologist, explore your choices and ask questions. Ensure that you get the information you need in bite-sized chunks and in a language you understand.”

Young women with breast cancer don’t have to face an uncertain fertility future alone. Spend time talking to experts, see a counsellor and weigh all your options. Your future can still be close to the one you envisioned before your diagnosis.

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