Pink ribbons are everywhere as we mark another Breast Cancer Awareness month. In addition to campaigns around awareness, new campaigns in the oncology and survivor communities are focused on treating the whole person instead of just the disease, mitigating side effects with balancing long term survival.
[caption align="alignleft"]Mary Craige with her son, Liam[/caption]As a young breast cancer survivor, I am keenly aware that breast cancer treatments take a toll on the body, even long after treatment has ended. One of the biggest issues that young women diagnosed with breast cancer face is infertility.
For years, medical oncology's main goal in breast cancer treatment was to eradicate the disease from the body through surgery, chemotherapy, radiation and endocrine therapy. These treatments leave many women with a host of long-term or permanent side effects like lymphedema, osteoporosis, infertility, cardiovascular and nerve damage as well as cognitive issues.
When I was diagnosed in 2010, I made it a priority to work with my medical team to mitigate these side effects through preventative therapies, exercise and nutrition.
As a 34-year- old young wife and mother, the most concerning side effect for me was infertility. At the time of my diagnosis, my son was 7 months old. I knew I wanted to have more children after treatment was complete. I was also worried about possible cardiovascular damage from radiation and the chemotherapy drug, Adriamycin (Doxorubicin), often referred to as the "red devil" due to its color and potentially devastating effects on the body. As an athlete who likes to run, bike and work out, I was also concerned about heart and lung damage and its impact on my ability to live the life I wanted.
Balancing survival with quality of life
Prior to treatment, I made several decisions about my treatment with my oncologist to balance long-term survival with quality of life. Luckily, my oncologist embraced treating the whole person and not just the disease. There is a risk of becoming pregnant after cancer – just how high is not known because relatively few patients have pursued that option long enough in the past to study. If there are cancer cells lingering in the body, then discontinuing standard treatment combined with the elevated estrogen from pregnancy could trigger them to grow and metastasize, which would be incurable. Still, my oncologist understood that a young women's breast cancer experiences are far different than an older women's and that our challenges can effect personal relationships and family planning.
Also, because chemotherapy kills rapidly dividing cells, my ovaries could be permanently damaged, rendering me infertile at the age of 34. My husband and I were faced with making quick and costly decisions before I began chemotherapy. We decided to undergo fertility preservation, a procedure that would preserve (or "freeze") embryos for future usage. At the time, this was the only option we were given.
The growth of oncofertility options
- "Oncofertility offers new options for young women with cancer who want to have kids,"The Washington Post (August 26, 2013)
- "Preservation of Future Fertility Through Ovarian Tissue Freezing," the Infertility Center of St. Louis
- "Having a Baby After Cancer," Women's Health (June 2010)
Today, fertility preservation choices for women who are faced with chemotherapy at a young age are even more expansive than they were just three years ago, thanks in large part to research advances. In 2010, the reproductive endocrinology practice I used did not preserve eggs for future usage because of challenges with the freezing and subsequent thawing process. When we visited the practice again in January 2013, one of the first things we learned is that egg preservation is now a regular practice — not just for women facing cancer but for women who want to postpone having a family.
My doctor is now seeing patients on a weekly basis, newly diagnosed with some form of cancer, who were educated by their oncologist about the long-term impact of chemotherapy on fertility. This truly shows that the conversations between physicians and patients are transitioning from treating only the disease to treating the patient and planning for her future.
New advances in medical technology that allow doctors to remove and preserve ovarian tissue are growing in popularity in the cancer community. This type of medical breakthrough helps breast cancer patients who cannot go through the hormone therapy needed to stimulate ovarian follicles for egg retrieval. Since roughly 75 percent of breast cancers are fueled by estrogen, egg stimulation using synthetic hormones can be dangerous. When I went through fertility preservation in 2010, doctors used a drug called Femara for this stimulation. Because my cancer was fueled by estrogen, they could not use traditional synthetic estrogen during this process. In lower doses, Femara is also used in endocrine therapy regiments in post-menopausal women with estrogen positive breast cancer to suppress estrogen from attaching to breast tissue.
Making the decision to expand our family
After two years of endocrine therapy and clear scans, my husband I made the decision to take a break from taking the drug Tamoxifen to try and expand our family. Because of the drugs I was given during chemotherapy (Adriamycin, Cytoxin and Taxotere), my body is in premature ovarian failure, a condition that is not reversible. This news was devastating to both of us, but we knew we had embryos that had been preserved for future usage. My oncologist supported our decision. In the three years I have been her patient, she has become a true advocate of oncofertility and the need to plan for the future prior to beginning treatment. (Here's a Washington Post article on that topic.)
Today, I am six months pregnant with a healthy baby boy. The journey has been rough and not without its ups and downs. I see my medical team regularly to ensure that the estrogen produced by the placenta is not causing cancerous tumors to grow again. In addition, I will resume endocrine therapy once the baby is born for another three years. Without the support of my oncologist in looking at my treatment holistically – and the advances in oncofertility – I would be a very different situation today.[divider]
[caption align="alignright"]Mary Craige[/caption]Mary K. Craige is a content marketing manager for LexisNexis Risk Solutions. In this role she manages strategic content marketing execution across all levels of planning, production, distribution, socializing, and performance measurement for the Health Care and Law Enforcement business units.