Finding Stability

Neoadjuvant Chemotherapy Breast Cancer Treatment and Fertility Concerns: New Study Offers Hope

New research suggests neoadjuvant chemotherapy breast cancer treatment doesn't have to be delayed due to fertility preservation.

When you’re diagnosed with breast cancer, you usually start treatment right away. If you have a certain type of breast cancer, your doctor may recommend neoadjuvant chemotherapy. This simply means your treatment will occur before you have surgery to remove your tumor.

Neoadjuvant chemotherapy breast cancer treatment, however, has been linked to infertility and early-onset menopause in many women who receive this therapy. According to the Journal of Clinical Oncology, almost half of all women who receive a breast cancer diagnosis are concerned about their reproductive options. But new research suggests fertility preservation may be possible without delaying the start of your chemotherapy.

Neoadjuvant Chemotherapy Benefits

As understanding of breast cancer evolves, neoadjuvant chemotherapy is gaining popularity as an effective treatment option for certain types of breast cancers. Your doctor may recommend this treatment option if you have a tumor that’s too big to be completely removed surgically. For many women, neoadjuvant chemotherapy breast cancer treatments shrink tumors and help to kill cancer cells that have may have spread.

Depending on your unique needs, your doctor may recommend neoadjuvant chemotherapy in addition to traditional chemotherapy, usually prescribed after surgery. This type of treatment can help your doctor plan a more personalized treatment approach for you and better determine which chemotherapy medications are most effective.

With neoadjuvant chemotherapy, your doctor closely monitors your response to treatment and can easily change the medication you’re receiving if it’s not effective. This may lower your risk of chemotherapy side effects and allow you to stop ineffective treatment sooner. Also, some research suggests neoadjuvant chemotherapy breast cancer treatment helps up to 25 percent of women avoid having a mastectomy, according to an article published in the journal Women’s Health.

Fertility Preservation and Neoadjuvant Chemotherapy

Oocyte (egg) freezing is a good option for preserving fertility for women who receive chemotherapy, according to the American Cancer Society. This process involves ovarian stimulation, which is timed to begin at the onset of your period. You receive several hormone injections over the course of a few weeks to stimulate your ovaries to produce as many eggs as possible. Then, your doctor collects your eggs and freezes them as is. You may also choose to fertilize your eggs and freeze the resulting embryos to be used after your cancer treatment is complete. The entire process can take up to six weeks.

But even with neoadjuvant chemotherapy’s benefits, as many as 26 percent of women who receive a breast cancer diagnosis avoid or delay treatment because of reproductive health concerns, says the Journal of Clinical Oncology. You may worry that starting neoadjuvant chemotherapy breast cancer treatment immediately will eliminate your options for preserving your eggs or embryos. But as new research shows, this isn’t necessarily the case.

According to a study published in the journal Human Reproduction, the ovarian simulation process is effective, regardless of when it’s started in your menstrual cycle. This means you don’t have to wait until your next period starts to begin ovarian simulation — your doctor can start this process immediately. If you have breast cancer, it may be possible to successfully preserve your eggs or embryos in only a couple weeks.

The accelerated ovarian stimulation process may mean you can avoid any delays in your neoadjuvant chemotherapy treatment. If you’re interested in this technique as a method of preserving your fertility, a conversation with your doctor can help determine if ovarian stimulation can be accomplished before beginning your treatment. Your doctor can help you decide what options are best for you depending on your individual circumstances and medical needs.

UVA Cancer Center's Breast Care Program offers personalized treatment options for people who have been diagnosed with Breast Cancer.

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Sarah Handzel, BSN, RN