A Biological Child Does Not Repair the Injustice of Breast Cancer at a Young Age

I was diagnosed with invasive breast cancer in November 2010, at the age of 30. The diagnosis came totally unexpected. I was really young and there was not a single case of breast cancer in my family. In addition, I did not have any germline mutation increasing the risk of developing the disease. In the course of two weeks, my life changed forever. One of the first things that came across my mind upon hearing that the lump I had found in my breast could be cancer was that, if this were confirmed and I were lucky enough not to die soon, I would have to face an extremely uncertain future. My fears turned out to be a sad reality: not only because I had breast cancer, but I also found out that available treatments could only reduce the chances of a recurrence. The disease can indeed come back even decades after the first diagnosis. At the current state of knowledge, it is impossible to predict if one is going to be on the good or the bad side of the statistics.

When still in a state of great shock, a friend of mine, who had been diagnosed with a different type of cancer years earlier, suggested that I consider preserving my fertility because chemotherapy could damage it. I still had to have surgery and my most pressing need at that time was to get rid of what I perceived as a monster growing inside my body. Not without reluctance, however, I started to gather information about the available techniques and, after surgery, discussed the issue with my medical team. All the procedures involved a great deal of medicalization and could potentially delay the start of adjuvant treatment. The road ahead of me was already long: my treatment plan consisted of four cycles of AC chemotherapy, followed by radiotherapy, one year of monoclonal antibodies and at least five years of hormone therapy with Tamoxifen and LHRH analog. Furthermore, it was as if my future had ceased to exist. The only way to cope with the anxiety of living with a life–threatening disease was to focus on the present. When I tried to imagine the years to come, the fear of not being able to see them became unbearable. My partner made it clear that he was going to support me whatever my decision would be. I chose not to undergo fertility preservation and to start chemotherapy as soon as possible. Ovarian suppression was started at the same time as chemo, though, to minimize its toxicity on my ovaries.

In the course of the last six years, my feelings towards parenthood have changed. Before 2010, I had always thought, perhaps without thoroughly considering what it would entail, that I was going to have children at some point in my life. Being diagnosed with an aggressive hormone–responsive form of breast cancer forced me to put this certainty in perspective. Clear guidelines on pregnancy after breast cancer, based on long–term and large–scale prospective studies taking biological factors and risk of relapse into account, are not available yet. My questions concerning pregnancy–related risks cannot therefore be answered. Many others have been crowding my mind.

Regardless of the effects of a pregnancy, my cancer could still spread and kill me. What if it happens after having a baby? Should I be able to conceive, would I want my child to go through the horrible experience of seeing his/her mother dying from breast cancer? What about the possibility of having a girl and living with the fear of her having breast cancer as well?

At the same time, I have started to reflect on how infertility is stigmatized, whereas women's heterosexual reproduction is seen as mandatory. Even when affected by serious illnesses, women are expected to put heterosexual reproduction before everything else including their own lives. For example, those who are diagnosed with cancer while pregnant and decide to delay or not to receive treatment because it could harm the foetus are commonly depicted as heroines by mainstream...