Introduction
Breast cancer is usually uncommon amongst young women, and only about 5 percent of women are diagnosed with breast cancer at an age of 40 years old. However, the disease may strike at any age (Chitale, 2011). In women between ages 35 to 54 years, breast cancer is reported to be the main cause of death. The incidence of the disease is notably increasing and a notable 46,000 new cases are reported every year (Williams, 2011). The main cause of this increase in the disease can be attributed to the fact that young women lack a routine to get screened regularly. The main reason for the lack of screening is because National Health Service (NHC) only offers to screen for women between the ages of 50 to 70 years of age unless one lump (Perry, 2011).
It is also notable that 90 percent of young women that are diagnosed with breast cancer at an early age are likely to survive the epidemic with the right treatment (Henderson, 2009). It would therefore be wise for young women, especially the ones that have a family history of having breast cancer or the risk factors that cause it, to have regular checks to avail medication in case they are diagnosed with cancer. The issue of fertility arises when it comes to women who are suffering from breast cancer since some of them are affected in their age of reproduction (Australia Institute Health and Welfare, 2009). There is therefore the need to ensure that fertility of the women is preserved, especially when the number of cases among women is on the increase. The paper aims at discussing the various treatment options available to women suffering from breast cancer, ways of making sure that fertility is maintained, and observing the advantages and disadvantages of available fertility preservation techniques.
Body
Breast cancer can be regarded as a collection of a group of diseases, in which the tissues in the breast divide them without any order. The malignant cells in the breast then tend to form too much tissue and eventually become a tumor. The tumor may grow to the new tissues or even break loose to the bloodstream and spread cancer to other organs (Trigg, 2002). Breast cancer is usually identified by different names. The names depend on where the disease starts; in the woman’s breasts. The breast is made up of 20 sections called lobes, which are further divided into lobules used in the transportation of milk to the nipple. The biggest percentage of breast cancer is cancer that develops from the duct. It accounts for about 86 percent of all breast cancer (Trigg, 2002). There are various stages of the spread of breast cancer. Stage 0 is the first stage; it is the beginning stage of cancer, and the cells have not spread outside the area within the tumor. Stage I is the second stage, in which the cancer is invasive and the tumor, in this case, is usually less than 2 centimeters. Stage II is the third stage and the tumor rages between 2 to 5 centimeters, and it is at this point that the tumor spreads to the lymph nodes. Stage III is the fourth stage and at this point, the tumor is about 5 centimeters thick (Epigee Women health, 2011). Having spread to the lymph nodes, cancer causes them to stick together. The stage is also not able to have cancer spread out to the mammary glands, the skin as well as the chest wall. Stage IV is the final stage in the spread of cancer and at this point, cancer spreads beyond the breast to other areas of the body like the lungs, bones, and the brain (Epigee Women health, 2011).
Before any treatment of breast cancer, some tests need to be carried out. It is these tests that guide doctors on the way they should treat breast cancer patients. There are three main tests involved in determining the best treatment for patients. The Estrogen receptor test is the first one. The test is meant to measure the amount of estrogen in the tissues. In case the estrogen is more than normal, cancer may spread quickly (National Cancer Institute, 2011). It is upon this realization that decision to block estrogen is made. The second test that needs to be carried out is the Human epidermal growth factor type 2 receptor test. The test is usually a laboratory test that is used to check the number of proteins in existence in the tissues. In case it is more than normal, there is the risk that it may spread faster and into the other parts of the body. Drugs like Herceptin and Tykerb are mostly used to minimize the number of proteins produced. The multigene test is another test that is carried out. It checks on the genes of the patient and also helps out to know if cancer may spread to the other parts of the body (National Cancer Institute, 2011).
Treatment of cancer among young women is similar to that of their older counterparts. Surgery is usually an unavoidable way of treatment and is usually done mostly before therapies. Generally, there are four main methods of treating cancer in patients. The first method is mastectomy. The method entails surgery on the entire breast. The second method is called lumpectomy (Vann, 2008). The method involves removing the tumor without removing the neighboring healthy tissues. The other method used is sentinel node biopsy. In this method, the surgeon determines the lymph nodes that are closest to the tumor and that receive lymph drainage from cancer. The lymph node is removed and tested for cancer. In case it has cancer, the other lymph needs to be removed and if it does not there are minimal chances of cancer being there (Partridge, 2007). Axillary lymph node dissection or what is commonly known as elimination of several lymph nodes in the other method. The method entails the removal of lymph nodes from other parts of the body like the armpits, which have already been affected by cancer. Notably, removal of the additional lymph nodes does not mean that the survival of the patient will increase. After all, this is done, the other step is subjecting the patient to therapies.
Chemotherapy is one common type of therapy that is used for patients who are suffering from cancer. It entails the usage of drugs to damage the cancerous cells. Doctors usually incorporate it if there is a high likelihood that cancer will spread to other parts of the body. By incorporating it, there is a reduction of the likelihood of cancer reoccurring again. Neoadjuvant chemotherapy is a certain type of chemotherapy, which is sometimes given before surgery to women who have large tumors (Domchek and Courtney, 2010). The main reason of giving this therapy is to make the tumor smaller so that the surgery will be much easier. Carrying out this type of therapy is also known to escalate likelihood of cure. The drugs used in chemotherapy tend to limit the growth of the malignant tissue and damage them. The side effect of chemotherapy certainly depends on the drugs given. Chemotherapy’s effect on breast cancer patient is that it reduces the patient ovarian reserve as well as the fertility. Before undertaking this therapy, it is important for patients’ ovary reserve. The importance of this is to determine the patient’s fertility line so that a decision can be arrived at, whether the patient needs fertility sparing options or not. The risk of infertility is actually more for patients using alkylating agents like cyclophosphamide. Such patients have a high risk of ovary toxicity and menopause as a result of the treatment. When treatment is done by an anthracyncline which has a lower dose of alkylating agent, there is lower risk of premature ovarian failure (POF). Usually, younger women tend to experience menstruation several months after treatment, which reinforces the fact that age predicates amenorrhea that results from chemotherapy.
Radio therapy is another type of therapy incorporated in treatment of breast cancer patients, in which beams of energy that are high-powered for example x-rays are used to destroy the cancerous cells. Radiation therapy may be done using two ways (Dador, 2011). The first way is external beam radiation where a machine is used to direct rays to the patient. Brachytherapy is the other way where a radioactive material is put inside the patient’s body to emit the rays. External beam radiation is the most common method and it reduces cancer greatly especially for patients whose sentinel node biopsy has tested negative. Radiation therapy has a high level of rays, which may lead to fertility complication when carried out on the whole body or when carried around the pelvis. However, the case is different when it comes to the breast part of the body as radiation therapy has a minimal effect on the ovaries and the fertility. The minimal effect may be attributed to the distance between the breast and the pelvic section
Hormonal therapy is the other type of therapy that is used in treatment of breast cancer patients. Also called hormone-blocking therapy, hormonal therapy reduces the chance of cancer ever returning again. It may be done through several ways. For one, Tamoxifen may be used; a moderator is used to prevent estrogen from being attached to the cancerous cells hence decelerating the growth of the tumor. A medication that halts the body from manufacturing estrogen may also be incorporated. Notable about this method is that it is done after menopause of the patient (Mayo Clinic staff, 2011). A drug like fulvestrant may be used; fulvestrant blocks the movement of estrogen from reaching the tumor and lack of estrogen to the tumor leads to its demise. Surgical menopause is also a type of hormonal therapy that is much effective to premenopausal women. It involves removal of ovaries or making the ovaries stop producing estrogen using a medication. Tamoxifen has no much effect on the fertility of the patient. However, in high doses it may have an ovulation effect. The only effect it is known to have is causing abnormal or absence of menses among patients. However, use of tamoxifen during pregnancy or when trying to conceive can cause abnormalities in fetus development or risk mammary tumors occurring.
In the recent years, there have been attempts to preserve the fertility of breast cancer patients. This is usually done through the following ways. One such method is ovary suppression. It is usually done during chemotherapy where the cycle involved in maturation is interrupted by use of gonadotropin-releasing hormone (Hulvat & Jeruss, 2009). The use of this hormone leads to reverse follicle mobilization that prevents increase of Follicle stimulation hormone (Dunn, 2009). However, there is conflicting evidence in usage of this method, and this calls for more experiments to be carried out to determine its effectiveness.
Ovary tissue cryopreservation is a method of preserving fertility where the patient is first subjected to laparoscopic surgery. The surgery involves removal of the entire ovary and is replanted at a later time. When the follicles survive three methods of re-implantation are used: re-transplantation of the ovarian tissue back into the patient’s pelvis, known as orthotropic auto grafting, re-implantation of the tissue back into a patient but in a different location, known as heterotopic auto grafting and finally, xenografting (Hulvat & Jeruss, 2009). The method is advantageous as it does not cause delay in the procedure and it does not require ovarian stimulation in the case of hormone sensitive breast cancers.
Oocyte cryopreservation is the other method of preserving fertility. It involves stimulating the ovaries, then harvesting and freezing the recovered oocytes. The oocytes are stored to the thawed at a later date and sperm injections can be used to fertilize the ovary (Huang et al., 2010). The method is advantageous as the women do not have to have a donor or a male companion. The method is also known to have less invasive procedure. The method has the disadvantage of the oocyte being damaged when they crystallize.
Conclusion
In conclusion, there has been a notable increase in the survival of breast cancer patients, which is a ray of hope to patients of this epidemic. The treatment methods, especially the surgical one are notably of minimal effect on the fertility of young women diagnosed with breast cancer. Therapies are also notable of being of minimal effect in the cases of the breast section of the patient. They are also known to have minimal effect the fertility of these women. The rise of new methods of preserving fertility among young women is also a beneficial idea to patients of breast cancer. However, there needs to be enough tests carried out to determine their effectiveness before they can be fully incorporated.
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