Fertility concerns impact breast cancer treatment decisions

A recent study has found concerns about fertility stop one third of young women with breast cancer from taking tamoxifen despite its known benefit in reducing the risk of breast cancer returning.

The study, which was published in the Journal of the National Cancer Institute also found one quarter of women who started taking tamoxifen stopped taking it before the recommended treatment period ended.

Study author Dr Jacqueline Jeruss, said the study revealed the importance of fertility to young breast cancer patients. “We need to find a way to bridge the gap between this patient survivorship goal and our concerns as physicians to facilitate the best treatment possible for our patients.”

The study patients had estrogen-receptor or progesterone-receptor-positive breast cancer and were recommended to take tamoxifen. Of those who declined tamoxifen or discontinued treatment concerns about fertility and side effects were the main factors patients mentioned as influencing their decisions.

Women taking tamoxifen are advised to avoid pregnancy due to the high potential for harm to the baby.

Previous studies, such as the IBIS-I study showed that five years of tamoxifen can reduce the risk of recurrence by 47% and mortality by 26%. Recent data suggests continuing tamoxifen for 10 years may be even more beneficial in preventing recurrence and death.

BCAC Committee Member, Greer Davis, was diagnosed with ER+ breast cancer at age 25 and has been taking tamoxifen for almost three years now. “No one in my medical team mentioned fertility and I didn’t know to ask. I only found out about potential fertility issues with chemo through my own research.”

Ms Davis says she is aware of the impact of taking five years of tamoxifen on her potential to conceive and plans to start trying for a baby very soon. She urges other young women who are diagnosed with breast cancer to push their medical team to give them all the appropriate information and to ensure they are connected with a fertility specialist early. “Fertility options need to be on the radar right from your initial diagnosis so you have the time to consider and undertake treatment should you wish to.”

Dr Jeruss said the study results show that for patients who express a desire for future fertility, appropriate counselling and referral to a fertility specialist should be offered as part of a wider treatment plan.

A new trial called POSITIVE is currently looking at whether premenopausal women who stop tamoxifen for a period of time while they become pregnant and then resume tamoxifen after pregnancy have a similar benefit to those taking a continuous course of tamoxifen.

22 Sept 2015

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