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Breast Cancer, Fertility, and the Young WomanShortly after they celebrated their third year anniversary, Mary Jane and her husband, Alan, made plans to start a family. After a year of trying to conceive, Mary Jane made an appointment with her gynecologist to make sure everything was in working order before she and her husband tried again the next month. During her examination, Mary Jane’s doctor noticed a mass in her breast and scheduled an ultrasound directed biopsy. The lab results revealed cancer. Mary Jane, only 34 years old, was shocked. How could this happen to her at such a young age? What would her husband think? Would they even be able to have children now? Mary Jane was heartbroken.

While coming to terms with a breast cancer diagnosis is difficult for any woman, younger women tend to have a harder time grasping its harsh reality. One of the reasons why they have a more difficult time coping is because younger women often deal with a cancer that is more aggressive than what is commonly found in elderly women. We treat breast cancer based on the biological characteristics of the cancer cells, not on the age of the woman. Some cancers, like those that are hormone-fed, can be treated with tamoxifen and women who respond well to this treatment do not need chemotherapy. However, there are cancers that are more serious and need to be handled as such. More aggressive cancers require more aggressive treatments, which in turn, produce more aggressive side effects. These side effects have a serious impact on young women who have just reached the peak of their adult lives: they’re traveling, their careers are taking off, they’re falling in love and starting families. After being diagnosed with breast cancer, their world stops as they slowly realize that the dreams that they have been living have to be put on hold.

Fertility is one of the biggest concerns for a young woman who has first been diagnosed with breast cancer. While every woman is treated on a case by case basis, we have found that fertility can be sustained during treatment through oocyte and embryo preservation. There is also a clinical study in the works which is looking at how stopping tamoxifen for a year or two to conceive impacts the mother’s risk for breast cancer recurrence. Although it is possible to have a healthy pregnancy after breast cancer, there is not much data that allows doctors to recommend (or not) conceiving after recovery. Ultimately, the decision is a personal one that should be discussed with your breast cancer doctors.

The American Society of Breast Surgeons (ASBS) is a society dedicated to providing a forum for the exchange of ideas and to promote education, research, and the development of advanced surgical techniques. Because of women like Mary Jane who need specialized care, I attended ASBS annual meetings to study with the experts. Learning from and interacting with them is both exciting and rewarding and has made me a better breast surgeon.

Mary Jane’s cancer was aggressive and her doctors suggested chemotherapy. She and her husband chose a regimen intended to preserve her fertility and two years later,  Mary Jane delivered a full-term, healthy baby girl. While Mary Jane is on tamoxifen now, she hopes to stop in a few years as they try for number two. Despite breast cancer throwing a wrench in their plans, Mary Jane and Alan are more than happy. They’ve grown stronger in their marriage and they now have a beautiful family. Life is good.