Gynecologist talked about maintaining fertility after breast cancer

Despite the fact that in Russia the average age of women with breast cancer is about 61 years, approximately one in 10 cases is detected in patients under 40. Is it possible to preserve fertility after treatment of the disease, gynecologist Olga Ulankina, an expert doctor at the Hemotest Laboratory, told Izvestia on October 2.

"According to the latest data, breast cancer in Russia is most often diagnosed in women aged 55 to 74 years. At the same time, starting from the age of 25, the number of diagnoses is gradually increasing. Several factors are associated with an increased risk of developing this disease. These include early onset of menstruation (before age 11), absence of childbirth, late menopause (after age 55), and abortions. Sedentary lifestyle, overweight, frequent alcohol consumption and smoking can also affect. Approximately one in ten cases is related to heredity — most often these are mutations in the BRCA1 or BRCA2 genes, as well as PALB2, NBS1, TP53, PTEN, STK11, CHEK2, ATM. A genetically determined type of breast cancer is characterized by an early onset (usually at 35-40 years old) and proceeds more aggressively," Ulankina said.

According to the expert, the disease occurs due to uncontrolled division of breast cells. They form a seal. Continuing to multiply, the cells penetrate into the surrounding tissues, lymph nodes in the armpits and near the collarbones, and then they can spread to other parts of the body.

The development of a malignant tumor in the breast at the initial stages is often asymptomatic. That's why self-diagnosis and annual breast examinations are so important. Early detection of the disease allows you to choose the most gentle therapy, which helps to preserve not only health, but also the possibility of future pregnancy.

"It is advisable to examine the breast yourself at least once a month. When probing, it is important to pay attention to lumps in the chest and under the arms, changes in the shape of the breast or nipple, the appearance of discharge (especially bloody), as well as redness of the skin. If these signs appear, you should consult a gynecologist. The doctor will conduct an examination and prescribe the necessary tests. For regular monitoring, women under the age of 40 are recommended to undergo breast ultrasound every year, and mammography after 40," explains the specialist.

Breast cancer treatment can significantly affect a woman's fertility, reducing her ability to conceive, carry, and give birth to a child. The preservation of fertility is influenced by the patient's age, the stage of the disease, the chosen treatment regimen, as well as chronic diseases and the general condition of the reproductive system.

Hormone therapy, chemotherapy, radiation therapy, and targeted medications can negatively affect ovarian function. This is often manifested by a temporary cessation of menstruation, which can later turn into ovarian insufficiency. The choice of the optimal way to preserve fertility is always individual and is made jointly with an oncologist, gynecologist and reproductologist, taking into account the type of tumor, treatment regimen, age of the woman and her plans.

"If there are several weeks before the start of treatment, the doctor may offer the patient cryopreservation (freezing) of eggs or embryos for further pregnancy planning using in vitro fertilization (IVF) after the end of therapy. If treatment needs to be started urgently, cryopreservation of ovarian tissue is used. With this method, small areas of ovarian tissue with immature eggs are extracted, frozen and stored until the end of cancer treatment. After that, they can be transplanted back to restore ovarian function. But the method has limitations. The method is not applicable at a high risk of ovarian cancer," Ulankina explains.

The doctor noted that gonadotropin-releasing hormone (GnRH) agonists are used as hormone therapy in patients with breast cancer. During the treatment period, they "turn off" the ovaries so that hormones do not stimulate tumor growth. At the end of treatment, the drugs are canceled, and the ovaries can work independently again.

"Having breast cancer does not always mean that pregnancy is impossible in the future. Timely diagnosis, individually selected treatment and modern methods of preserving reproductive function can help a woman realize her plans for motherhood. Psychological support is equally important. Counseling with a psychologist or participation in support groups and the attention of loved ones help to cope with fears and restore self—confidence," the expert concluded.

On August 18, Irina Vasilyeva, head of the Mammology clinic at the European Medical Center (EMC), told Izvestia the main myths about breast cancer. According to the expert, the most dangerous myth about breast cancer is the belief that if there are no symptoms or lumps, then everything is fine.

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