Two-thirds of women who are treated for cancer as children will eventually conceive, although it may take them longer than other women to do so, according to a study published today in Lancet Oncology.
The possibility of future infertility is a concern for parents seeking treatment for girls with childhood cancers, but physicians have had limited data on which to base treatment recommendations. Some studies have suggested birth rates were lower for survivors of childhood cancer. To provide better data, a multi-institution team of researchers collected and compared fertility data from women enrolled in the Childhood Cancer Survivor Study, including 3531 female childhood cancer survivors and 1366 female siblings, who served as controls.
The data indicate that compared with women in the sibling group, women who had been treated for childhood cancers did have a higher risk of infertility, defined as not conceiving after more than 12 months of attempts. But the good news was that even after experiencing such difficulties, most of the women with a history of childhood cancer treatment (64%) became pregnant. On average, childhood cancer survivors took longer than members of the control group to become pregnant.
The authors were concerned, however, to find that although the cancer survivors were as likely as the sibling control group to seek care for infertility, they were less likely to receive infertility treatment. The authors said it was not clear whether physicians were less likely to offer treatment to survivors, whether survivors were disinclined to pursue such treatment, or if other factors were at play. Survivors who had received pelvic radiation, alkylating agents, or total body irradiation were at higher risk of infertility than those who had not.
“What we found delivers a really nice message to clinicians,” said Lisa Diller, MD, medical director of the David B. Perini, Jr. Quality of Life Clinic at Dana-Farber Cancer Institute in a statement. “If you have a patient who is a childhood cancer survivor and is self-reporting clinical infertility, the chances are good that she will become pregnant. Women who have a history of childhood cancer treatment should consider themselves likely to be fertile. However, it might be important to see an expert sooner rather than later if a desired pregnancy doesn’t happen within the first 6 months.”