Young women may think about having children, but when diagnosed with breast cancer, patients often face these decisions long before they thought they would have to.
For Maggie Loucks, NP-C, who was diagnosed at age 28, preserving fertility became a major factor in deciding what treatment plan to pursue.
“You’re 28-years old and you want to do everything you can to ensure this doesn’t come back, but at the same time you want to preserve your fertility as much as possible,” says Loucks, who sought care at the Susan F. Smith Center for Women’s Cancers at Dana-Farber.
Although the process was stressful, Loucks says she was fortunate to be part of the Program for Young Women with Breast Cancer, as well as Dana-Farber’s Young Adult Program, which provided resources and support.
“Dealing with this potential loss of fertility can lead to intense emotions, like sadness and anger. Getting good, clear information and a realistic sense of what may or may not be possible often helps,” says Ann Partridge, MD, Loucks’ oncologist and the founder/director of the Program for Young Women with Breast Cancer.
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Loucks worked with Partridge to develop a plan that would be effective but also allow her to have a family in the future. Because breast feeding was important to her, Loucks decided to get a lumpectomy instead of a mastectomy. She was also referred to the Reproductive Endocrinology Group at Brigham and Women’s Hospital to discuss options to ensure fertility preservation, and decided to harvest embryos in the four weeks between her surgery and the start of her chemotherapy.
For Loucks, there was a choice between a new regimen to treat her cancer that was less likely to affect her future fertility, and a more standard regimen that was much more likely to decrease fertility, which Partridge calls “kitchen-sink” chemotherapy. Based on Loucks’ preferences and concerns as a young woman with breast cancer, and because Loucks did not have a high risk tumor, she and Partridge chose a treatment plan that included an effective chemotherapy with less risk for infertility.
Some cancer treatments, such as the hormonal therapy Tamoxifen, do not damage the ovaries, while standard chemotherapy can often damage the ovaries directly and reduce fertility. If treatment does affect fertility, patients have several other options they can pursue, Partridge says:
- Cryopreservation involves embryo freezing, freezing an unfertilized egg (a less successful method) or freezing ovarian tissue (a method that is highly experimental).
- Medical ovarian suppression, which recent data has suggested is effective, involves hormone shots during cancer treatment to shut down ovaries so that they may be protected from chemotherapy.
- Using donor embryos or donor eggs after treatment.
In cancer care, one size does not fit all and although her treatment plan may not be the most aggressive, Loucks said she was grateful that Partridge knows there are a lot more factors than just getting rid of the cancer.
“My original life plan was a little bit derailed but I’m very lucky to be where I am now under the care of Dr. Partridge and Dana-Farber,” says Loucks, who is now a nurse in Dana-Farber’s Center for Sarcoma and Bone Oncology.
Two years after her diagnosis, Loucks is taking advantage of her free time until her treatment ends and she can focus once again on starting a family.