38 women's Day is coming, I wish the majority of female sisters, happy holidays, good health!In recent years, breast cancer has become a hig
38 women's Day is coming, I wish the majority of female sisters, happy holidays, good health!
In recent years, breast cancer has become a high incidence of malignant tumors at home and abroad. With the progress of comprehensive treatment of breast cancer, more and more patients with breast cancer were cured or in remission of disease, some patients with breast cancer is not fertile, cured after fertility requirements. With the release of the national two-child policy, part has given birth to young women, there is still another child we wish to talk about fertility issues in patients with breast cancer.
According to the China Association for breast cancer treatment guidelines and norms (2015 Edition) the family guidance: Although there is no evidence that growth will affect the prognosis of patients with breast cancer, but in the choice of whether or not to have children, and when the family must fully consider the impact of risk and treatment of patients with disease recurrence of offspring, and the patients should also have sufficient communication. The following should be considered: the birth of surgery and radiotherapy in patients with breast carcinoma in situ after. The lymph node negative invasive breast surgery patients of cancer after 2 years. The lymph node positive breast cancer patients after surgery of infiltration of 5 years. The need for adjuvant endocrine therapy for patients with endocrine therapy, for example, stop, Zoladex or other estrogen receptor modulators tamoxifen for 3 months before pregnancy (selectiveestrogenreceptormodulaors, SERM), until the end of breast-feeding after birth, and then continue to endocrine therapy.
Modern evidence based medicine suggests that breast cancer does not increase the risk of recurrence, and may even have a protective effect.
The commonly used treatment for breast cancer includes surgery, chemotherapy, radiotherapy, endocrine therapy, targeted therapy, and so on. These commonly used treatment methods have an impact on fertility of female patients? Will these treatments affect the fetus?
1. Chemotherapy: chemotherapy plays an important role in the comprehensive treatment of breast cancer. One of the main concerns of the patients is whether there is a potential teratogenic effect of chemotherapy drugs in breast cancer There are few studies on the health status of pregnant women after breast cancer treatment. Overall, the next generation of health status and no more risk than the general population. But a study of a group of 5752 cases of breast cancer after breast cancer found that the proportion of people who choose to have abortions is high, up to 20%-44%, which may reflect the concerns of patients and doctors about the safety of breast cancer.
Effect of chemotherapy on mature follicles can lead to reversible menopause, for primordial follicle damage will cause permanent amenorrhea and premature ovarian failure, which leads to infertility. Chemotherapy induced premature ovarian failure and the patient's age, the type of drug, dosage and period of treatment and other factors are closely related. The risk of chemotherapy-induced premature ovarian failure increases with the increase of age; the greater the chemotherapy drug dose, the longer the course, the greater the risk of premature ovarian failure.
Gonadotropin releasing hormone (GnRH), a hormone secreted by the hypothalamus in the pituitary gland. The analogs of the hormone have been used in clinical practice. In patients with breast cancer after application, can cause amenorrhea, menstrual recovery after discontinuation of the drug, the equivalent of "ovariectomy". For young women with fertility requirements, the use of these drugs during chemotherapy, to a certain extent, protect the ovary.
2, radiotherapy: the current radiotherapy mainly for the local breast, but also may have a small amount of radiation through the muscle and blood flow changes to the pelvic cavity and ovarian radiation. Breast cancer radiotherapy standard dose can through in vivo scattering to the pelvic, but far less than the amount of radiation can cause premature ovarian or uterine injury. Although not to cause premature ovarian failure, but during radiotherapy should avoid pregnancy and obtain oocytes.
3, endocrine therapy: for ER/PR (+) breast cancer patients, years of endocrine therapy can significantly improve the prognosis. Most patients of childbearing age endocrine therapy selection of tamoxifen, tamoxifen or aromatase inhibitors and also gonadotropin-releasing hormone analogues (GnRHa, we used Zoladex) combined, there are very few single GnRHa. Part of the research that tamoxifen can increase the risk of premature ovarian failure, some people think that the use of tamoxifen will not affect reproductive function. Animal studies have shown that long-term exposure to tamoxifen has a risk of fetal malformations and increased breast cancer risk, so it is recommended that tamoxifen therapy should be avoided during pregnancy and pregnancy. The use of aromatase inhibitors (we used letrozole, anastrozole, exemestane, etc.) has better curative effect and GnRHa. Aromatase inhibitors stimulate ovulation role in assisted reproductive technology, aromatase inhibitors and tamoxifen is widely used for ovulation induction, with the use of aromatase inhibitors in postmenopausal pregnancy reported, but aromatase inhibitor effect on pregnancy is still unable to research.
There is no final answer to the safety of breast cancer after pregnancy. This is also the International Breast Cancer Collaborative Group is looking forward to a clinical study to answer questions.
Finally, I can only say that got breast cancer, still can have fertility, still can be pregnant, but must be careful.