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Iranian Journal of Breast Diseases
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1- Reproductive Health Department, Qom University of Medical Sciences, Qom, Iran
2- Department of Epidemiology and Biostatistics, School of Health, Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran ,alesaleh70@yahoo.com
2- Department of Epidemiology and Biostatistics, School of Health, Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran ,
Abstract: (18 Views)
Breast cancer is the most prevalent cancer among women of reproductive age (1). Following progress in breast cancer therapies and rising survival rates, it is crucial to confront the frequently neglected obstacles that survivors encounter after finishing their breast cancer treatment. Although overcoming cancer is a significant achievement, numerous survivors face ongoing physical, emotional, and social challenges that linger well beyond their treatment (2).
A significant yet frequently neglected concern in cancer survivorship is the difficulties breast cancer survivors encounter when contemplating motherhood (3). As early detection and treatment improve, numerous young women overcome breast cancer but face challenges related to fertility, complicated medical choices, and emotional anxiety about future pregnancies (3, 4).
Treatments for breast cancer, such as chemotherapy, radiation, and hormone therapy, can significantly affect fertility, resulting in premature ovarian failure or conception issues. Although options for fertility preservation, such as oocyte freezing, are available, numerous patients either remain uninformed about them or encounter financial and systemic obstacles to obtaining them (5). Inadequate coverage of fertility preservation in breast cancer survivors due to lack of access, high cost, poor insurance coverage, haste to start treatment, and poor information is considered one of the major barriers to fertility preservation in Iran (6, 7). Moreover, societal misunderstandings and fear of relapse generate psychological pressures, causing many survivors to feel unsure regarding planning for their families (8).
In Iran, the issue of childbearing is a sign of femininity, and infertility for any reason can threaten marital life or lead to divorce (9). On the other hand, pregnancy for many women after breast cancer treatment seems more like a myth than a reality (10). Recent research has offered reassuring information regarding the safety of pregnancy following breast cancer, even in hormone receptor-positive instances (11). Nonetheless, there are still deficiencies in patient education, awareness among healthcare providers, and insurance coverage related to fertility preservation.
Recent protocols recommend that individuals diagnosed with cancer should be evaluated and counseled about reproductive risks at the time of their diagnosis and throughout their survivorship period. As a result, options, such as freezing embryos, oocytes, and ovarian tissue, are recommended for women before the treatment. These protocols emphasize the importance of establishing a multidisciplinary family planning team within oncology centers. Additionally, discussions regarding each fertility preservation method should cover its effectiveness, potential risks, possible fertility rates, time requirements, and associated costs (12, 13).
In Iran, options, such as cryopreservation of oocytes, embryos, and ovarian tissue, as well as controlled ovarian stimulation, ovarian suppression with GnRH analogues, and ovarian transposition (oophoropexy), are available. Each of these methods is recommended for specific types of cancer, taking into account factors, including marital status, age, the feasibility of delaying cancer treatment, and previous chemotherapy processes (14).
We urge the medical community, policymakers, and support organizations to improve oncofertility counseling at diagnosis to ensure informed decision-making, expand insurance coverage for fertility preservation procedures, enhance research on long-term pregnancy outcomes for survivors, and provide psychosocial support to address anxieties around motherhood post-cancer. By addressing these challenges, we can empower breast cancer survivors to make informed choices about their reproductive futures, ensuring that survivorship includes the possibility of parenthood for those who desire it. We appreciate your consideration of this important issue.
Recent protocols recommend that individuals diagnosed with cancer should be evaluated and counseled about reproductive risks at the time of their diagnosis and throughout their survivorship period. As a result, options, such as freezing embryos, oocytes, and ovarian tissue, are recommended for women before the treatment. These protocols emphasize the importance of establishing a multidisciplinary family planning team within oncology centers. Additionally, discussions regarding each fertility preservation method should cover its effectiveness, potential risks, possible fertility rates, time requirements, and associated costs (12, 13).
In Iran, options, such as cryopreservation of oocytes, embryos, and ovarian tissue, as well as controlled ovarian stimulation, ovarian suppression with GnRH analogues, and ovarian transposition (oophoropexy), are available. Each of these methods is recommended for specific types of cancer, taking into account factors, including marital status, age, the feasibility of delaying cancer treatment, and previous chemotherapy processes (14).
We urge the medical community, policymakers, and support organizations to improve oncofertility counseling at diagnosis to ensure informed decision-making, expand insurance coverage for fertility preservation procedures, enhance research on long-term pregnancy outcomes for survivors, and provide psychosocial support to address anxieties around motherhood post-cancer. By addressing these challenges, we can empower breast cancer survivors to make informed choices about their reproductive futures, ensuring that survivorship includes the possibility of parenthood for those who desire it. We appreciate your consideration of this important issue.
Type of Study: Letter to Editor |
Subject:
Nutrition, psychology, sport
Received: 2025/05/2 | Accepted: 2025/08/25
Received: 2025/05/2 | Accepted: 2025/08/25
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