May 30, 2024 – Maggie Louks was diagnosed with: Breast cancer 12 years ago, on the age of 28. The nurse from Boston, who now lives in London, had many concerns after her diagnosis – including the impact of the treatment on her ability to change into pregnant and have a healthy child in the longer term.
Given that she was very young on the time of diagnosis, Louks' doctors desired to treat her cancer aggressively.
“The standard treatment at the time was for me to receive 'kitchen sink chemotherapy' – basically pumping me full of intense drugs in the hope of minimizing a relapse,” said Louks, now 40.
Louks later switched to a less intensive chemotherapy, which was successful. She was also proactive when it comes to Fertility preservationWhen she finished her cancer treatment, she tried to get pregnant. A primary attempt at embryo transfer failed, but she was in a position to obtain recent eggs through IVF collection.
“We transferred two embryos, resulting in beautiful twin girls, Sloane and Everly, who were born in July 2020,” she said. A 12 months later, she and her partner conceived spontaneously and eventually welcomed a “third miracle baby” named Kingsley.
Breast cancer occurs less regularly in women of childbearing age, but will not be rare; 10% of diagnosed patients are 45 and younger. The joyful ending described by Louks seems unattainable for a young woman who has just been confronted with breast cancer, but current research shows that it is feasible for a big proportion of those patients.
A new study is the primary study to follow young breast cancer survivors for 10 years after treatment. The very long time span from treatment to pregnancy consequence allowed researchers to obviously see for the primary time the small print that meant success for these women.
“The majority of women we observed who tried to get pregnant succeeded, and the majority of those women had a live birth experience,” said the lead study writer. Ann Patridge MD, MPH, deputy chief of medical oncology and director of the adult survivorship program at Dana-Farber Cancer Institute and Brigham and Women's Hospital in Boston. “This is really good news, as is the fact that the vast majority of women diagnosed will go on to survive their breast cancer for a long time.”
The research
More than 1,000 women – 1,213 to be exact – participated within the study. Of those patients, 197 told researchers that they had actively tried to get pregnant after their breast cancer treatment. Researchers said that 73% of girls who tried to get pregnant became pregnant and 65% gave birth alive.
The researchers found that young breast cancer survivors conceived a baby on average at age 32. This was true whatever the stage of the cancer on the time of diagnosis and treatment. Older women were less successful at conceiving.
In addition, 50 percent of girls who successfully conceived had never been pregnant before, and 72 percent of girls who had a healthy baby had never carried a baby to term. Twenty-eight percent of participants had frozen their eggs or embryos before chemotherapy.
“Women who stored their eggs or embryos were more likely to become pregnant and have live births,” Partridge said, noting that 68% of girls attempting to conceive had received chemotherapy, but it surely didn’t appear to have a negative impact on their probabilities of a successful pregnancy.
The majority of participants (76%) were diagnosed with hormone receptor-positive tumors, which are sometimes endocrine therapyand 57% of those women had undergone this hormone therapy during their cancer treatment.
“It is not recommended that women taking the drug become pregnant,” Partridge said. But inside the study's group of girls, “I suspect that some of them became pregnant while taking it, and that some women stopped their treatment early to try to become pregnant,” she said.
Previous research findings by Patridge from a study called the POSITIVE test showed that ladies could safely interrupt endocrine treatment for a certain time frame.
In that study, she said, researchers found that ladies could stop their therapy after 18 to 30 months, wait just a few months, after which attempt to get pregnant through artificial insemination. Many became pregnant, had a baby, and breastfed before starting hormone therapy again.
“Most importantly, in POSITIVE, we found that most women resumed their hormone therapy and had a safe outcome. The number of cancer recurrences in the group was below the safety threshold,” she said.
The key takeaway: A big number of girls can and do have healthy babies years after surviving breast cancer. But that doesn't mean every young breast cancer survivor should attempt to get pregnant.
“The decision is a very personal one – it's made by the woman, her family and her doctor, in relation to the remaining risk of recurrence,” Partridge said. “You have to ask yourself, 'Am I comfortable bringing another life into the world if recurrence does occur and the future is uncertain?' We all have uncertain futures, but if you're a breast cancer survivor, it's important to make the right decision for you.”
What is oncofertility?
For women who wish to change into pregnant, Oncofertilityan emerging medical specialty that mixes each cancer and reproductive medicine may be of crucial help.
“Oncofertility is a bridge between oncology and reproductive health,” said Laurie McKenzie, MD, Associate Professor of Gynecologic Oncology and Reproductive Medicine on the University of Texas MD Anderson Cancer Center in Houston.
The goal of oncofertility is to enhance a girl’s reproductive possibilities through procedures equivalent to Fertility preservationFertility preservation will help women avoid damage to their reproductive system, equivalent to their ovaries, through the use of shields during radiation treatment, regulating the ovaries through injection therapy, or surgically relocating the ovaries so that they are protected during cancer treatment. And the necessity for this technology is evident: Current research from the University of Hong Kong found that only about 44% of girls with breast cancer have even heard of fertility preservation, though lots of these patients can have children safely and successfully through oncofertility. A recent French study It has also been found that many ladies with breast cancer are unaware that they’ve access to or can seek advice from an oncofertility specialist, so it is crucial for patients to talk to their GP and ask for a referral.
An oncofertility specialist will help a patient who has just received a diagnosis to weigh all of her options, including the potential for freezing her eggs. Many women may not realize how much time this process can take.
“Egg freezing takes 2 to 3 weeks,” McKenzie said. “Not all patients are suitable, so it's important to know your fertility status before considering it.”
In addition, genetic concerns may also be discussed with an oncofertility specialist.
“If you are concerned about BRCA1 or BRCA2, there are ways to prevent passing it on to your offspring,” McKenzie said. Preimplantation genetic diagnosis is one such option that a specialist can inform a patient about.
Knowledge is power
Louks stays healthy and is convinced that it is important for each young breast cancer patient to study fertility early on.
“My advice is to talk to your oncology team from the start,” she said. “Discuss all your options and how they might affect your course of treatment. Think beyond breast cancer, too. After that devastating diagnosis, it can be very hard to look beyond the first few weeks and months – but think about the years ahead.”
Louks resides proof that for many ladies who’ve breast cancer and still dream of becoming moms, a joyful consequence is feasible.
“Our house is wild and crazy and beautiful and I am so grateful every day,” she said.