Fertility and adjuvant treatment in young women with breast cancer

Women of childbearing age with breast cancer are often concerned about whether they will become infertile after treatment, and for those who wish to bear children, whether a subsequent pregnancy will alter their risk of disease recurrence. The risk of chemotherapy-related amenorrhea (CRA), menopause, and infertility appear to be related to patient age and type of treatment received, though data regarding actual fertility following treatment are limited. There are options available for fertility preservation for young women who wish to have a biologic child after breast cancer and are at risk for infertility. Options include cryopreservation of embryos, oocytes, ovarian tissue prior to treatment, and ovarian suppression through chemotherapy. However, most of these are considered experimental, and there are limited data regarding the safety of such strategies. There has been concern that pregnancy after breast cancer may worsen prognosis in light of the endocrine manipulations used to treat breast cancer, particularly for women with hormone sensitive disease. Several studies addressing the potential risk of pregnancy after breast cancer have not revealed any negative effect on prognosis. However, these studies have significant limitations, and concerns about a negative impact for some remain. Ongoing and future prospective studies evaluating fertility and pregnancy issues for young breast cancer survivors are warranted for this vulnerable population facing this difficult issue.