5. "Worse comes to worst, I have a safety net": Fertility Preservation among Young, Single, Jewish Breast Cancer Patients in Israel
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PART II Achieving Pregnancy and Parenthood 71 5 “Worse comes to worst, I have a safety net” Fertility Preservation among Young, Single, Jewish Breast Cancer Patients in Israel Daphna Birenbaum-Carmeli, Efrat Dagan, and Suzi Modiano Gattegno Breast cancer is the most prevalent type of cancer among women in developed countries (Curado et al. 2007), including Israel, where every year about four thousand new breast cancer patients are diagnosed. Roughly 250 (approximately 7 percent) of these are women under the age of forty (Israeli Ministry of Health, National Cancer Registry n.d.). The frequency of early-onset breast cancer is similar to that reported in the US Surveillance, Epidemiology, and End Results registry, which found approximately 10 percent of breast cancer diagnoses in women of childbearing age (National Cancer Institute n.d.; Zhou and Recht 2004; Jemal et al. 2010; Pollán 2010; American Cancer Society 2009; Kothari and Fentiman 2002). Breast cancer at an early age is more likely to be associated with a family history of breast and ovarian cancer, especially in women harboring a germline BRCA1/2 mutation (Bleyer et al. 2006). Among Ashkenazi Jews, 2.5 percent of the population was found to carry one of the three founder mutations in the relevant genes (King, Marks, and Mandell 2003). Most breast cancer tumors are diagnosed at early stages with high rates of five-year survival. Yet the majority warrant systemic adjuvant cytotoxic therapy that may cause ovarian failure. Moreover, when the tumor is endocrine -sensitive, a five-year course of adjuvant hormonal therapy is typically required, further postponing the option of pregnancy (Goldhirsch et al. 2009; Anders et al. 2008; Lee et al. 2006; Sonmezer and Oktay 2006; Barthelmes and Gateley 2004; Reichman and Green 1994). Even if cyclic menses resumes, fertility may be compromised due to treatment damage, as well as the natural age-related decline in ovarian reserve (Klemp and Kim 72   Abortion Pills, Test Tube Babies, and Sex Toys 2012). About one in six young cancer survivors experiences premature ovarian failure (Larsen et al. 2003), which is a major factor in the 30 percent to 50 percent reduction in the probability of cancer survivors having a live birth in comparison with control subjects (Chung et al. 2013). The growing number of women of reproductive age who survive breast cancer following gonadotoxic therapy has resulted in increased interest in fertility preservation (Litton 2012). For many young breast cancer patients, having children after the completion of anticancer treatment is a major life concern (Partridge et al. 2004). In a survey of young cancer survivors conducted in Cleveland, Ohio, 75 percent of those without children said they wanted to have a child in the future (Schover et al. 1999). Infertile women demonstrated twice the prevalence of depression, higher scores of anxiety and hostility, and lower life satisfaction when compared to fertile women. These symptoms further intensified in cancer patients (Schover 2012; Cousineau and Domar 2007; Wirtberg et al. 2007). In surveys of over a thousand young breast cancer survivors in the United States, the majority of the women stated that they had intended to become pregnant when they were first diagnosed with cancer (Partridge 2008). Yet only 10 percent of young breast cancer patients did something to protect their fertility (Chung et al. 2013). In very large population-based studies showed that 3 percent (Muller et al. 2003) to 8 percent (Blakely et al. 2004) of the women who have had breast cancer give birth after the diagnosis . The low rates of fertility preservation may reflect, among other things, the urgency to commence cancer treatment, limited knowledge regarding the impact of chemotherapy on fertility and regarding options to preserve fertility, and insufficient counseling on these issues (Peate et al. 2011). Therefore, the American Society of Clinical Oncology and other organizations have issued guidelines to address this matter (Lee et al. 2006). Several options for fertility preservation are available for women before gonadotoxic therapy, including cryopreservation of embryo, oocyte, and ovarian tissue. Embryo cryopreservation is the oldest and most established fertility preservation method and has been routinely used for storing embryos after in vitro fertilization (IVF). This approach requires approximately two weeks of ovarian stimulation with daily injections of follicle-stimulating hormone from the onset of menses. In most cases embryo freezing is considered the first line of action, although the risks associated with ovarian stimulation in breast cancer patients, especially those with cancers that are estrogen receptor positive, is an active area of investigation (Chung et...

Subject Headings

  • Human reproductive technology -- Middle East.
  • Human reproductive technology -- Africa, North.
  • Birth control -- Middle East.
  • Birth control -- Africa, North.
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