Fertility Concerns for Breast Cancer Rx

Tamoxifen use less likely among breast cancer patients due to fertility concerns

(RxWiki News) Young breast cancer patients commonly have fertility concerns, and those concerns may affect their decisions about treatment.

A new study from the University of Michigan School of Medicine found that young women may be turning down an important breast cancer treatment because of fertility concerns.

"Despite the importance of fertility to young breast cancer patients, availability of fertility preservation options, and relative safety of pregnancy among breast cancer survivors, fertility preservation is often underutilized and under-discussed in clinical settings," wrote lead study author Jacqueline S. Jeruss, MD, PhD, a professor of obstetrics and gynecology-fertility preservation at Northwestern University Feinberg School of Medicine, and colleagues.

Tamoxifen (brand names Soltamox, Nolvadex) is used to decrease the risk of recurrence and death from breast cancer.

Breast cancer patients should not become pregnant while on tamoxifen, as the drug may cause birth defects. The length of treatment may also narrow the window for a woman to conceive.

Dr. Jeruss and team looked at 515 patients under the age of 45 who had stage 0-III hormone receptor-positive breast cancer.

Tamoxifen is usually recommended for these cancers, as it reduces the risk of recurrence by 47 percent and the risk of death by 26 percent.

Tamoxifen is typically recommended for at least five years and may be continued for up to 10 years.

Dr. Jeruss and team collected data on demographics, disease and treatment. They also interviewed patients who refused tamoxifen or discontinued the treatment early.

The women who declined or discontinued tamoxifen were likely to also decline radiation therapy and chemotherapy. They were also more likely to be smokers.

When the diagnosis was ductal carcinoma in situ (DCIS), women were more likely to decline or discontinue tamoxifen.

DCIS is limited to the milk ducts, has not spread and is not considered life-threatening. DCIS does raise the risk of more aggressive breast cancers, however.

Women who declined tamoxifen said the potential side effects and fertility concerns were the primary reasons for their decision.

Women who discontinued treatment early also cited side effects and concerns about conception, pregnancy or birth defects.

According to Dr. Jeruss and team, doctors don’t always discuss options for women with breast cancer who are concerned about fertility.

For instance, tamoxifen treatment may be delayed to allow for pregnancy. Other fertility strategies may also be available.

In an editorial about this study, Shoshana M. Rosenberg, ScD, MPH, and Ann H. Partridge, MD, MPH, wrote, "[These results] not only shed new light on the role of side effects and concern about side effect on non-adherence in young women, but also draw attention to the impact of fertility concerns on [treatment] decision-making."

This study and editorial were published in the August issue of the Journal of the National Cancer Institute.

The Center for Reproductive Health After Disease, the National Center for Translational Research in Reproduction and Infertility, and Northwestern University funded this research.

Drs. Rosenberg and Partridge had ties to the Dana-Farber Cancer Institute.


Review Date: 
August 19, 2015