Published November 20, 2014
Young women with cancer often aren't counseled about the risk of losing their fertility due to treatment or their options for saving their eggs, a new study from California suggests.
Researchers found that since the early 1990s, only one in every 25 women diagnosed with cancer at age 40 or younger decided to go through with egg- or embryo-freezing procedures, even though at least half said they'd like to have kids after treatment.
"More times than not it's still the patient that is basically saying, 'This is important to me,'" said Dr. Mitchell Rosen, head of the Fertility Preservation Center at the University of California at San Francisco School of Medicine, who worked on the study.
"Even if they have children, if there's a glimpse of thinking about whether they would want to have another child, they should be raising this question with their physician and letting them know that this is important to them," he told Reuters Health.
The new findings are based on surveys of more than 1,000 California women who were diagnosed with cancers including breast cancer and leukemia between 1993 and 2007, when they were 18 to 40 years old.
About 900 of those women had cancer treatment that could affect their fertility down the line, including chemotherapy and radiation to the pelvic region.
Depending on their diagnosis, between 47 and 63 percent of women said that at the time they got cancer, they still wanted to have kids at some point.
A similar number -- 61 percent -- reported getting counseled by one of their doctors about the impact treatment could have on their fertility, as well as their options for preserving it.
And about four percent went through with egg- or embryo-freezing procedures -- a rate that increased over time from no women in 1993 to six to ten percent during the last few study years.
The total cost of such procedures can run from $8,000 to $24,000, Rosen and his colleagues report in the journal Cancer. Fertility preservation for cancer patients isn't typically covered by insurance in many states, including California.
Recommendations from the American Society of Clinical Oncology call for doctors to address the possibility of fertility problems in all reproductive-age patients before starting cancer treatment, and to be prepared to talk about options such as embryo-freezing.
Rosen's past research has shown that women's quality of life is higher when they're referred to a doctor who can give them accurate information about fertility problems that could come with cancer treatment and the chance to do something about it.
"Obviously not all women are interested in fertility preservation, but it's really, really important at least to have the conversation with them," said Susan Klock, a psychologist who discusses fertility preservation with cancer patients at the Northwestern University Feinberg School of Medicine in Chicago.
She said some women just want to focus on their cancer diagnosis and may be too stressed out to even consider fertility treatment -- and others are happy with their family as it is.
But women who would like the possibility of future children should ask their doctor about their options, said Klock, who wasn't involved in the new study.
"I think the hardest thing is if a woman never had this discussion and then maybe her breast cancer is treated and she's five to 10 years out and says, 'Gee, now I really wish I would have done this,'" she told Reuters Health.
"I think this regret is a very hard thing to deal with."