Fertility Help Not Equal for Cancer Patients
After adjustment for age, desire for future children, income, ethnicity, disease type and stage, and treatment type, higher education was associated with increased counseling (OR 1.4, 95% CI 1.0 to 2.1). There was a trend towards lower likelihood of receiving counseling in patients earning a household income of less than $30,000 relative to those earning $30,000 to $100,000 annually (OR 0.7, 95% CI 0.4 to 1.2).
Pursuit of fertility preservation was significantly associated with younger age, desire for future children, and educational attainment.
There was a strong trend towards decreased use of services in Latina women versus white women, who were 80% less like to preserve fertility (OR 0.2, 95% CI 0.0 to 1.3). No fertility preservation was recorded among black or nonheterosexual patients.
What causes infertility?
-Infertility is often a major concern to men and women of childbearing age, who are undergoing treatment for their cancer.
- Common causes of infertility in patients with cancer include:
Chemotherapy - This is related to the type of drug, dose and length of treatment.
Radiation - due to pelvic radiation in males and females. This is also dependent on the dose of radiation that was received, and the age during therapy.
Cancer-related surgery - in women, with cancer of the endometrium, or ovaries, who may have had a hysterectomy- infertility may result depending on the size and type of tumor. Men who have received a penectomy, orchiectomy, removal of the prostate gland, or seminal vesicles (which produce semen), may experience infertility
Age - also an important factor, more so for women than men. Women who are older are more likely to go into an early menopause (the stopping of monthly periods) from their treatment, than younger women.
Women older than 35 at time of diagnosis also tended to be less likely to preserve fertility than patients ages 18 to 25, though this difference also failed to reach significance (OR 0.1, 95% CI 0.0 to 1.4).
The authors provided a number of possible explanations for the disparity in care. Patients with bachelor’s degrees may have a higher health literacy than patients without a degree and may be more likely to bring up the topic of fertility preservation.
Additionally, the researchers noted that lower incomes have been associated with poorer outcomes in treatment, which may reflect on a patient’s inability to acquire counseling or preservation services, particularly since such services are not routinely covered by health insurance.
Couldn’t the increased levels of estrogen in fertility treatments increase risk for breast cancer?
Exposure to estrogen and progestin after menopause has been linked to increased risk for breast cancer for women in their 50s and 60s, but fertility drugs do not expose women to estrogen at that age, says Samantha Pfeifer, MD. She is chair of the practice committee at the American Society for Reproductive Medicine.
Pfeifer says fertility drugs raise estrogen levels for up to seven days at a time. “Estrogen levels are not significantly raised for a prolonged period of time.”
Is it possible that women undergoing fertility treatment have other risk factors unrelated to fertility drugs?
Yes. There are many factors that affect breast cancer risk.
Most women undergoing fertility treatment are over 32 and have never had a child, which is a risk factor for breast cancer, says Jennifer Litton, MD. Litton is a breast medical oncologist at the University of Texas M.D. Anderson Cancer Center.
The researchers noted that the low number of nonheterosexual respondents may have underpowered results, but noted that nonheterosexual females showed no difference in desire for future children and did not receive counseling services.
Minority patients may have faced linguistic, cultural, or economic barriers. Black patients often wait longer with untreated infertility before seeking fertility treatment than do whites, the authors wrote.
The study was funded by the National Institutes of Health.
The authors had no conflicts of interest to disclose.
Primary source: Cancer
Source reference: Letourneau JM, et al “Racial, socioeconomic, and demographic disparities in access to fertility preservation in young women diagnosed with cancer” Cancer 2012; DOI: 10.1002/cncr.26649.
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