Young women with breast cancer

In New Zealand, around 400 women under the age of 44 are diagnosed with breast cancer. These patients will have similar diagnostic and treatment procedures as older breast cancer patients. However, they may have concerns specific to their younger age.

Young women with a family history of breast cancer may benefit from a referral to Genetic Health Services.

Breast cancer treatment can affect fertility, including inducing premature menopause. Chemotherapy damages the blood vessels around the ovaries and immature eggs. Younger patients may see menstruation and fertility recover after treatment, but this will depend on the chemotherapy administered, the dosage and their age at the start of treatment. Women aged over 35 have a higher risk of permanent infertility from cancer treatment. Patients who have a higher reserve of eggs in their ovaries may recover their fertility but are likely to experience menopause earlier than its natural onset.

Patients wishing to undergo fertility preservation procedures should discuss this with their medical team before they start treatment. For patients undergoing chemotherapy, a referral to a fertility clinic will need to take place before treatment starts. Treatments may be structured as to optimise fertility preservation, if this is a priority for the patients.

Fertility preservation before treatment

Patients can freeze embryos (suited to those with a partner) or freeze their eggs (suited to those who don’t have a partner). These are both government funded for women who are aged under 40, have no children and have a body mass index of less than 32.

Patients should discuss fertility preservation with their medical team as IVF can delay the start of treatment. If necessary, a short, 12-day protocol can be administered. A short course of letrozole can be administered to counteract the effects of ovarian stimulation on the patient’s breast cancer.

Fertility during treatment

Patients are advised to avoid pregnancy when undergoing treatment for breast cancer. Women may be advised to discontinue oral contraceptive use after a breast cancer diagnosis. They should discuss the use of condoms, diaphragm or non-hormone secreting IUD with their medical team.

Fertility after treatment

Patients can expect menstruation to return 12-18 months after chemotherapy. Fertility may recover even in the absence of menstruation, and menstruation does not mean that the patient’s fertility has been unaffected. Fertility can be monitored through blood tests and/or ultrasound, however these results may not be reliable for patients on adjuvant endocrine therapy.

For women whose ovaries have been damaged by treatment, egg donation may be an option. Two cycles are funded for menopausal women under the age of 40.

Patients will generally be advised to wait for two years after finishing treatment before considering pregnancy, to mitigate the risk of early cancer recurrence. Plans for pregnancy should be discussed with the patient’s medical team. There is no evidence that cancer treatment can harm children conceived after treatment completion.

Some patients may be diagnosed when they are pregnant. See more information about pregnancy-associated breast cancer.

Breast cancer treatment can induce premature menopause and the risk is higher in patients who are closer to the age of natural onset. Younger women are more likely to experience side effects of oestrogen deficiency with the onset of premature menopause as they undergo a more significant shift in hormone levels. Patients struggling with menopausal side effects should discuss how to treat and manage these with their medical team. See more about menopause on endocrine therapy.

Premature menopause can also affect bone density and patients may have a higher risk of bone loss or osteoporosis. Patients should be monitored and/or treated for bone health while on endocrine therapy. Patients can also maintain their bone health by:

• Getting enough calcium (two servings a day)
• Getting enough vitamin D
• Doing regular weight-bearing exercise (e.g. jogging, walking, tennis, etc)
• Limiting alcohol
• Quitting smoking.