Impact and Timing of Breast Cancer Radiation Therapy and Fertility Preservation

Abstract

Upfront fertility counseling improves quality of life for young breast cancer patients planning for pregnancy post-treatment. We reviewed the literature on the impact, if any, that breast radiation may have on post-treatment fertility and fertility preservation decisions in order to facilitate fertility counseling. While the ovaries and uterus should not receive significant doses of radiation during breast radiation, negligible radiation doses (that are too low to induce ovarian failure) may result from internal scatter. Despite a low risk of infertility from breast radiation, data suggest that women may have chosen mastectomy to avoid whole-breast radiation due to fertility concerns. Although multiple studies have provided encouraging data with successful pregnancies after breast cancer treatment, the number of patients that underwent breast radiation and required fertility preservation methods are rarely reported. In conclusion, the impact that breast radiation appears to have on fertility is low and, in our opinion, should not result in patients choosing mastectomy over breast conservation therapy due to fears of infertility. However, further studies specifying the patients receiving breast radiation and requiring fertility preservation methods are warranted to help reassure patients and their providers.