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Posts Tagged ‘Cancer’

Effect on the chance of subsequent pregnancy quantified for first time

Date:July 3, 2017

Source:European Society of Human Reproduction and Embryology

For the first time, a large population study has quantified the chance of pregnancy after treatment for cancer diagnosed in girls and women aged 39 or under. This landmark study, which linked all cancers diagnosed in Scotland between 1981 and 2012 to subsequent pregnancy, found that the cancer survivors were 38% less likely to achieve a pregnancy than women in the general population. This detrimental effect on fertility was evident in almost all types of cancer diagnosed.

“This analysis provides the first robust, population-based evidence of the effect of cancer and its treatment on subsequent pregnancy across the full reproductive age range,” said presenter Professor Richard Anderson from the MRC Centre for Reproductive Health, Queen’s Medical Research Institute at the University of Edinburgh, UK.

“The major impact on pregnancy after some common cancers highlights the need for enhanced strategies to preserve fertility in girls and young women.”

Professor Anderson will present the results of the study today at the Annual Meeting of ESHRE in Geneva.

The need for better access to fertility preservation has become more pressing in recent years for two reasons: first, the improved rates of survival in young women and girls diagnosed with cancer; and second, improvements in the techniques of freezing eggs and ovarian tissue to restore fertility.

This latest study, which cross-linked 23,201 female cancer survivors from the Scottish Cancer Registry with hospital discharge records, revealed 6627 pregnancies among the cancer survivors when nearly 11,000 would have been expected in a comparable matched control group from the general population.

For women who had not been pregnant before their cancer diagnosis, 20.6% of the cancer survivors achieved a first pregnancy after diagnosis (2114 first pregnancies in 10,271 women), compared with 38.7% in the control group. Thus, women with cancer were about half as likely to achieve a first pregnancy after diagnosis as were controls.

The analysis also found that the chance of pregnancy was reduced in all age groups, with substantial variations between different cancer diagnoses — notably, reduced pregnancy rates in women with cervical cancer, breast cancer and leukemia. However, those cancers diagnosed later within the study period (2005-2012) were associated with higher rates of pregnancy than those diagnosed earlier (1981-1988), suggesting that for some cancer treatments the impact on fertility has reduced.

The diagnosis and treatment of female cancers are known to affect fertility for several reasons: some chemotherapy regimens can cause damage to the ovary, and this can occur at any age; radiotherapy can also compromise female fertility through effects on the ovary, uterus and potentially those brain centres which control the reproductive axis.

However, Professor Anderson stressed that the results of the study related only to subsequent pregnancy itself, and not to the incidence of infertility caused by cancer treatment. “Some women may have chosen not to have a pregnancy,” he explained. “Thus, while these results do show an expected reduction in the chance of pregnancy after chemotherapy and radiotherapy, having a pregnancy after cancer does involve a range of complex issues that we cannot address in this study.”

With rates of cancer survival increasing in both young male and females, fertility preservation ahead of treatment has an increasing role to play in fertility clinics. However, Professor Anderson described such services in all parts of the world, including the USA and Europe, as “very variable.” “Oocyte and embryo freezing are regarded as established,” he said, “but ovarian tissue cryopreservation is considered experimental, although it is the only option for prepubertal girls.”

He added that the results of this study would allow clinicians to advise girls and women more accurately about their future chance of pregnancy. “They emphasise the need to consider the possible effects on fertility in girls and women with a new cancer diagnosis. The implications of the diagnosis and planned treatment and, where appropriate, options for fertility preservation should be discussed with the patient and her family. Even for patients considered at low risk of infertility as a result of treatment, a fertility discussion is recommended before treatment begins.”

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Major breakthroughs in healthcare are few. It is rare that the paradigm shifts in such a manner that our whole way of thinking about how we should address a topic radically changes. It appears this will begin to happen much more frequently as scientific breakthroughs occur at an expanding and much more rapid pace.

The HPV Vaccine may be seen as a wonderous breakthrough in science as soon as a generation has past and recieved it purported benefits.

One such example of this phenomenon is the recent approval by the FDA (Food and Drug Administration) of a vaccine for the Human Papilloma Virus. Strong evidence suggests that this intervention may grow into something just short of a panacea for cervical cancer (we know the drug manufacturers hope so!). At the same time, medical history will likely look back at this occasion as the time that vaccines were introduced to protect us from things that we never even dreamed were possible.

In the beginning of my medical career, the thought of a vaccine for a cancer seemed preposterous. Now it is reality. Only time will tell. This concept of the self correcting nature and the non dogmatic objective review of pier reviewed literature will be reviewed in an upcoming article on Science – How and why it works. However, for now we are relegated to make informed desicions as best as we can on the evidence that we have. That body of work is very strong and becoming more reliable everyday.

For over four decades the scientific community and the clinical community of basic science community and the clinical community of Obstetricians and Gynecologists, and ancillary health care professionals learned that women who had certain subtypes of HPV, were at much higher risk for bad changes in the cervical cells, and those bad changes occasionally led to the horrendous disease, cervical cancer.

In the beginning of the 1960’s we watched about 1/45 women over a lifetime DIE from this heinous illness. The introduction of aggressive cytology through pap smears with the microscope (colposcopically directed) biopsies of those sick cells led to an enormous decrease (almost 1/3, absolutely extraordinary) in the incidence of the precursor disease and the full blown out illness of cervical cancer.

HPV sadly became one of the most prevalent sexually transmitted diseases. Before the onslaught of AIDS the barrier free sexuality of the 60s and 70s facilitated the transmition of hordes of STD’s which still continues today, in not quite the same tsunami of spread.

If you desire more detailed information on these items, please say so in your comments. This will help guide the tone and theme of the site. It belongs to all of us, to make us all healthier. We benefit from that glorious communion. We will learn together how detailed, how medical, how general, we want these items to be and we will try and reach common denominator that suits the majority. We will not be perfect (who is?) but we will strive to the best education and information possible.

Very soon depending on who you are, you must engage your health care provider with the discussion: it is appropriate for me? my daughter? my significant other, to receive the HPV vaccine. This will be a difficult question. Wow, extremely difficult. Just imagine! Some of our daughters will be 11. The thought of vaccinating an 11 year old against a sexually transmitted disease is intuitively abhorrent, however, the reality is, a generation from not we may come close to eradicating one of the primary gynecologic cancers in women – using a vaccine. A cancer that strikes and kills women in their prime, as opposed to the other illesses whcih tend to have a higher prevalance as the individual gets older. This is not to be taken as it is a better cancer, but I suspect we are saddenned greatly when more of a potential life is snuffed, a mother taken from her daughter when she needs her most. The potential to rid ourselves of this monstrosity, now that is astonishing, I recommend you do your reading and education, as this is a big one.

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