Women are surviving cancer today in record numbers. Now that oncologists have made such great strides toward effective treatment, we need to focus more on helping women prepare for their life beyond cancer. Unfortunately, many of the most effective cancer treatments can damage a woman’s ovaries leaving them infertile or even induce premature menopause.
In 2006[u1] , the American Society for Clinical Oncologists published guidelines on discussing “fertility preservation” with cancer patients. At that time they estimated that about 55,000 cancer patients per year were 35 or younger and should be offered options to prevent lifelong infertility. One of the concerns expressed by the panel at that time was that the cost of fertility preservation was prohibitive. Since that time, many organizations have taken steps to remove financial barriers by providing compassionate care options; making treatment widely accessible. I am pleased to work at such a center [u2] and have therefore had the good fortune to help many cancer patients in planning their future families.
Recently, a group of women that had survived cancer treatment agreed to participate in a study[u3] investigating whether or not they had been counseled about fertility preservation prior to undergoing cancer treatment. Unfortunately, even though these women were between 18 and 40 years of age; only 61% had been counseled. They did find a more recent trend toward counseling then when the study began a decade ago. Most importantly, the women that had received counseling were far less likely to harbor regrets; even if they did not choose to freeze eggs or embryos prior to cancer therapy. In fact, women that discussed their options with a fertility specialist were most at peace with their decision and demonstrated the highest quality-of-life scores. So if you or someone you know has recently been diagnosed with cancer, consider scheduling a consultation with a reproductive endocrinologist. It’s a decision that will be appreciated over time.
Mark Twain popularized the saying that “there are three kinds of lies: lies, damned lies and statistics” in his 1906 autobiography. Since that time, healthcare providers like myself often refer to this quotation when yet another study comes out producing numbers which scare our patients. I was reminded of this when discussing a study published this week in the journal Human Reproduction which boldly stated that IVF treatment “doubles a woman’s risk of developing ovarian cancer.” In reality, they found that patients that underwent IVF treatment between 1983 and 1995 had a risk of developing ovarian cancer estimated to be at 0.71% compared to a baseline risk of 0.45% in untreated women. Not only is that a lower increase than stated but they did not find any correlation between dose of medication and cancer risk. This means their theory lacks biological plausibility. Maybe more importantly is that they neglected to point out those women that successfully become pregnant experience a dramatic reduction in their risk of developing ovarian cancer. That fact is particularly important since pregnancy rates have increased profoundly during the intervening years. Unfortunately, those facts are often overlooked when inflammatory studies like this are published.
As a patient advocate, I do feel that it is important that we inform our patients of every possible risk but that we also provide a fair and balanced perspective. To date, there have been at least15 studies that have looked for a link between fertility medications and ovarian cancer without finding any increase in risk. By contrast, I believe that this is 4th study suggesting a slight increase may exist. So although we cannot say that there is no rise in cancer risk associated with IVF treatment, we can state that any risk increase is small and that a successful pregnancy likely offsets that risk. Better still, we can also recommend our patients that are concerned to consider taking an oral contraceptive when not attempting to become pregnant as reported in 45 studies—recognized as reliable by the American Cancer Society—indicate that doing so can reduce ovarian cancer risk by at least half. So in considering your treatment options, look beyond the statistics and consider how any treatment as well as its outcome may actually impact your health and wellness.