Cancer - The F WordPublished on: 09 April 2018
Back in February, I read in the news about one of the latest scientific breakthroughs of human eggs being matured in the lab for the first time. I was interested to read about the potential implications of this, particularly what it might mean for fertility treatments for those who have been diagnosed with cancer at a young age. The recent blog by my colleague, Lucy Small, highlights the devastating impact a cancer diagnosis at a young age can have on a woman’s fertility. Focus tends to be on treatment, and understandably so, but we must not forget about the potential impact of a cancer diagnosis on fertility, particularly for younger people who receive a diagnosis. The F word is a big deal for many younger cancer sufferers, and not everybody gets a chance to talk about it.
How old is “young”?
The risk of a “young” person getting a cancer diagnosis is of course quite low, statistically speaking, but exactly how old is “young”? The American Cancer Society suggests that for the purposes of statistics, “young adults” are generally regarded as between 20 and 39 years old. I think it depends on the type of cancer, but with people living longer and with women often deciding to have children at older ages, this might alter our perception of what “young” is. In breast cancer for example, “young” seems to mean under the age of 45. A family history of this in relatives under the age of 50 does increase a person’s risk of developing this disease and would generally warrant enhanced screening in accordance with NHS guidelines. With cervical cancer, the highest incident rates seem to be in the 25 – 29 age group and according to Cancer Research, more than half of cervical cancer cases in the UK each year are diagnosed in women under the age of 45. For young men (aged 25-49), testicular cancer is the most common cancer in the UK, accounting for around 14% of all cases in 2013-2015. These are all ages where people might be planning to start a family.
Undergoing chemotherapy and radiotherapy carries a risk of reducing fertility. This may not have such a big impact for “older” patients but for younger people who have not yet had, and may want to have children in the future, this impact can be life changing.
For hormonal driven cancers, such as breast or womb, the treatment does not end after the initial chemotherapy and/or radiotherapy and patients may have to undergo hormonal therapies for years afterwards. For example, tamoxifen, a breast cancer drug, can often be prescribed for up to 10 years following active treatment. This carries the risk of inducing early menopause and will have a massive impact on couples considering adding to or starting a family.
Sometimes patients can be offered fertility preservation options before beginning their treatment, but there is no one size fits all approach and much will depend on the individual’s particular circumstances and type of cancer, and even local health care provider (the familiar case of post code lottery). Women can sometimes freeze their eggs before starting treatment, or even ovarian tissue, and men could undergo sperm banking for example. If this is not available on the NHS for a particular patient, some people may have to pay for the cost of going private.
At what is already an incredibly difficult time, it is just another thing for cancer patients to have to think and worry about, particularly for those young adults who have not even contemplated or yet thought about having children. Time may also be of the essence in starting treatment, and patients may have to make the difficult decision to delay treatment to explore and undergo fertility preservation, with the possibility that this could increase cancer risk and impact on their prognosis.
Hope for the future?
Fertility is often something young people take for granted and so may be the last thing a young person receiving a cancer diagnosis thought they might have to think about.
As I understand it, the eggs that have been matured in the lab are technically ready to be fertilised and, if this leads to healthy embryos, this could in theory be used to help women who have had cancer at a young age. There is also potential for the technique to be used to preserve fertility in children having cancer treatment. More investigation is needed before this could be a potential clinical option but hopefully this is a positive step forward for fertility preservation and treatment, particularly for those whose fertility is affected by a cancer diagnosis at a young age.