“I don’t want cancer to define my future.”
There are many things that make a breast cancer diagnosis challenging at a young age. For Roshni Kamta—who was diagnosed at age 22 with triple-negative breast cancer—she often felt alone in her experience. Her friends were starting their careers, and her peers at the treatment facility were decades older than her. For example, one of the things that distinguished her from the older patients was the need for fertility preservation.
“The hardest thing to have to deal with when being diagnosed at a young age with breast cancer is going through fertility [preservation],” says Kamta. “My medical team gave me 10 days before starting chemo to freeze my eggs and make the decision.”
Certain types of breast cancer treatment can cause infertility. Chemotherapy, for example, stops the ovaries from releasing eggs and estrogen, leading to early menopause. In some cases, the fertility challenges may be temporary, but in other cases, it may continue to make it difficult to become pregnant long after breast cancer treatment has ended.
Supporting Young Women with Breast Cancer
“Fertility preservation in young people with breast cancer is a huge issue,” says Elisa R. Port, MD, breast surgeon at Mount Sinai Health System who treated Kamta. Despite being an important topic for young patients to consider, studies have shown that not all cancer patients receive information about fertility preservation.
One of the concerns with fertility for cancer patients of child-bearing age is that doctors often want to begin cancer treatments immediately. That means patients need to make decisions quickly and start fertility preservation promptly, if that’s what they wish to do.
“Of course we want to start treatment as early as we can, but to do a cycle of egg harvesting can take a few weeks, and so getting that person in to see someone right away, so as not to delay treatment, can be quite critical,” says Dr. Port.
Making Tough Decisions About Fertility Preservation
As of 2014, the average age of mothers when they have their first child is 26 years old, according to the Centers for the Disease Control and Prevention. Furthermore, over half of first births happen when mothers are above the age of 26, and a third of first births happen to mothers over age 30.
In other words, a significant portion of U.S. women are waiting to have children. As a result, it can be challenging for young women facing a cancer diagnosis to make choices about their fertility.
“When my surgeon told me that I had to freeze my eggs, I was like, ‘What?’” recalls Kamta, who was 22 at that time. “I [didn’t] want cancer to define my future, and I [wanted] to have that option later on, and so that's why I did the egg-freezing.”
Customizing Treatment for the Individual
Allowing time for fertility preservation is one of the many ways that doctors individualize cancer treatment.
“A diagnosis of breast cancer is [almost] always traumatic, but for someone so young, you always have to be mindful of how this diagnosis and the treatment for breast cancer has to fit within the context of their life,” says Hanna Irie, MD, oncologist at Mount Sinai Hospital who treated Kamta. “In Roshni's case, she pursued egg harvesting and freezing, which is one way.”
Another way Kamta’s cancer treatment team helped to protect her fertility is with injections that help protect the ovaries. This therapy essentially suppresses the normal activity of the ovaries for the duration of chemo “to help protect [the] ovaries from the toxic effects of chemotherapy,” says Dr. Irie. Learn more about options to preserve fertility during cancer treatment.
Unfortunately, conversations about fertility don’t always happen before treatment. It might be up to the patient to bring it up. “For a patient, if you are in your child-bearing ages, and you want to consider child bearing, it's important to ask about that … and to be your own advocate,” says Dr. Port.
Dr. Port is a surgical oncologist at the Dubin Breast Center at Mount Sinai Hospital.
- Fertility issues in girls and women with cancer. Bethesda, MD: National Cancer Institute, 2020. (Accessed on November 13, 2020)
- How cancer and cancer treatment can affect fertility in females. Atlanta, GA; Centers for Disease Control and Prevention, 2020. (Accessed on November 13, 2020)
- Mean age of mothers is on the rise: United States, 200-2014. Atlanta, GA: Center for Disease Control and Prevention, 2016. (Accessed on November 13, 2020)
- Oktay K et al. Fertility preservation in patients with cancer: ASCO clinical practice guideline update. J Clinic Oncol. 2018 Jul;19(36).