Breast Cancer News
Friday, July 21, 2006
American Society of Clinical Oncology Issues First Guideline Recommendations on Fertility Preservation in People Treated for Cancer
ASCO recently issued a clinical practice guideline about fertility preservation in people treated for cancer, the first in a series to address cancer quality-of-life issues
By Tai Danielle Parks, LBBC Staff
S.D. Lee, et. al., American Society of Clinical Oncology Guideline Recommendations on Fertility Preservation in People Treated for Cancer. Fred Hutchinson Cancer Research Center, Seattle, WA.
To address the issue of fertility after cancer, the
American Society of Clinical Oncology recently released guidelines for oncologists to use when advising women and men about their fertility options.
ASCO, one of the world’s largest groups representing cancer practitioners, convened a panel of oncologists to review literature on fertility preservation methods and make recommendations. This unprecedented review shows the importance of advocacy by young women affected by cancer, who have lobbied for more information about fertility options.
Why Create Guidelines on Cancer Treatment and Fertility?
Some breast cancer treatments can make it difficult for women to conceive a child or maintain a pregnancy, but many doctors do not discuss fertility before women begin treatment.
Chemotherapy, radiation therapy and surgery may cause temporary or permanent infertility. Fertility also may be compromised even if regular menstrual periods continue during treatment or return afterward. In addition, cancer treatment can cause premature menopause, which shortens the length of time a woman is fertile.
The guideline was developed in part because past studies found that approximately half of oncologists do not initiate fertility discussions with women at the time of diagnosis. Among the reasons cited:
· Physicians prioritize discussions about immediate or potentially life-threatening complications
· Data on the risk of infertility with chemotherapy have been poor or non-existent
· A lack of understanding about the importance of fertility to the woman
· A belief that the cost of fertility treatment would be prohibitive
· Because the woman’s prognosis is poor
Based on the findings of the panel, “ASCO has developed an evidence-based clinical practice guideline to help physicians build a bridge between cancer care and fertility treatment,” said
Kutluk Oktay, MD, senior author of the guideline. “Until now, there has been no clear guidance for discussing and initiating fertility preservation with cancer patients. This guideline is the first of its kind, and will become the standard guide for cancer patients, fertility specialists, and oncologists.”
Options for Preserving Fertility Before Cancer Treatment
The panel, comprised of oncologists, fertility preservation experts and patient advocates, reviewed literature on fertility preservation methods. They studied the evidence on fertility preservation in women and men diagnosed with cancer, and the appropriate role of the oncologist in advising individuals about fertility options. The guideline focuses on fertility preservation options available before cancer treatment, and advises that the type of cancer and other personal preferences and circumstances may affect the options available.
The panel found that fertility preservation methods are applied relatively infrequently, but the method with the highest likelihood of success in women is
embryo (fertilized egg) cryopreservation, or the harvesting of eggs, followed by in vitro fertilization and freezing of embryos for later use.
Additional methods reviewed included
oocyte (egg) preservation, the collection and freezing of unfertilized eggs;
ovarian tissue cryopreservation, the removal and freezing of part of the ovary for later re-implantation; and the use of hormone therapy to protect ovarian tissue during chemotherapy.
Other fertility preservation methods are designed to spare reproductive organs from surgery or radiation damage.
Some of these methods are investigational—for example, ovarian tissue cryopreservation—but you may be able to access these treatments through a clinical study.
What This Means for Me
Not all cancer treatments prompt infertility, but infertility is an important, often overlooked, complication of some breast cancer treatments. If fertility is important to you, discuss your concerns with your healthcare team as soon as possible after your diagnosis.
If you aren’t sure how to get started, ask your doctor whether you are at risk for treatment-related fertility problems. This discussion should take place as early as possible, as many of the available fertility preservation options require time to perform before cancer therapy begins. Your doctor may be able to refer you to a fertility expert or provide further information.
Read the guidelines from ASCO on fertility preservation and cancer.
Rate this article
Linear Mode
