Does Fertility Treatment Raise Breast Cancer Risk?
Breast Cancer Diagnosis and In Vitro Fertilization – Are they Connected?
Questions concerning fertility treatment and a link to breast cancer are frequently asked. And when E! News anchor Giuliana Rancic told the world that she had been diagnosed with breast cancer it seemed that there would be a new round of speculation about an association between the two factors, breast cancer and fertility treatment.
In response to the issues raised, breast cancer experts and their counterparts in the in vitro fertilization (IVF) field have given their views on the subject.
When asked if an association between IVF and breast cancer really exists, the experts point out that there is no evidence to support this view. They point out that the drugs used in IVF have not been found to have a connection to breast cancer. However oncologists acknowledge that women who have undergone IVF for extended periods of time should be studied and any findings assessed. The long term effects of IVF have still to be fully studied.
It is already known that in post menopausal women there is a link to breast cancer from drugs and hormones commonly used in IVF. These items include estrogen and progestin. However women receiving fertility treatment are younger and still have periods. The chair of the American Society for Reproductive Medicine, practice committee, Samantha Pfeifer, MD, shares these views and points out that, “Estrogen levels are not significantly raised for a prolonged period of time” during normal IVF treatment.
Other experts explain that many factors affect the risk of developing breast cancer. Most women who consider IVF are over 32 years old and have never had a baby. Being over 32 years and childless is a factor known to increase the risk of breast cancer. Jennifer Litton, MD works at the University of Texas M.D. Anderson Cancer Center and is a breast medical oncologist. She endorses this view and says that many factors affect breast cancer risk.
For example Litton says that even if a woman has a family history of breast cancer or the gene mutation BRCA she will be given the same advice by her IVF specialist as any other woman. Litton explains, “As long as you don’t have a cancer diagnosis, at this point, there is no evidence that IVF will increase risk for patients with greater risk factors, even those with the BRCA gene mutation or family history.”
Some people believe that a mammogram should take place before IVF treatment commences. However Samantha Pfeifer, MD, does not hold that view. But she does think that national guidelines for health safeguarding should be followed. She says, “You want to make sure the Pap smears are up to date and that any routine screening has been done. We follow the established guidelines of mammograms starting at age 40 for women who don’t have significant risk factors”. She is aware, however, that starting times for mammograms is a controversial subject.
If a woman has previously had breast cancer it can be possible for her to use IVF as a means to become pregnant. But this is complicated because many factors are at work in this situation. Issues like age are important, normally an IVF patient is older and women become less fertile as they age.
It is common for doctors to recommend that the woman should have been free of cancer for at least five years before considering pregnancy. And if the woman had certain cancer treatments then those treatments may have damaged her reproductive system. This factor should have been discussed with the cancer specialist before treatment began. As Litton explains, there are options available to the woman before cancer treatment begins. She says, “What we often do for our patients, especially if they are over 30, is consider fertility preservation before they go through chemo by retrieving eggs and freezing the eggs or embryos. Freezing embryos is the standard. Freezing eggs is still considered experimental.”
Eric Widra, MD is a member of the Society for Assisted Reproductive Technologies, and is chair of the practice committee. He supports the view that IVF is do-able after breast cancer but is realistic and confirms that success, “depends on several factors”.