At 45, can my breast cancer treatment affect my fertility?

Question

Hello doctor,

I am a 45-year-old woman diagnosed with stage 1 hormone-positive, HER2(Human Epidermal Growth Factor Receptor 2) -negative breast cancer. The tumor is about 2 centimeters with no lymph node involvement. I have been given a choice between a lumpectomy with radiation or mastectomy. I am also told I will need hormonal therapy afterward. Please tell me,

What are the effects of surgical treatment?
What is the duration of hormonal treatment?

What are the common side effects of Tamoxifen or Aromatase inhibitors?
Does this affect future fertility?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

You have been diagnosed with stage 1 hormone-positive, HER2 (Human Epidermal Growth Factor Receptor 2) -negative breast cancer measuring 0.2 inches and with no lymph node involvement. In your case, both lumpectomy with radiation and mastectomy are effective treatment options, and the choice often depends on your personal preferences and lifestyle.

A lumpectomy with radiation is breast-conserving, offering similar long-term survival rates to mastectomy. But it requires several weeks of daily radiation treatments and carries a slightly higher risk of local recurrence compared to mastectomy, though this risk is generally low.

A mastectomy removes the entire breast, eliminating the need for radiation in most cases and further reducing the risk of local recurrence. However, it is a more extensive surgery and may affect your body image. It may also need reconstruction in the future.

Hormonal therapy is recommended after either surgery since your cancer is hormone-receptor positive. It usually lasts five to 10 years.

Tamoxifen (a selective estrogen receptor modulator), often used in premenopausal women, can cause side effects like;

Hot flashes.
Vaginal dryness.
Irregular periods.
Increased risk of blood clots.

Aromatase inhibitors (a type of hormone therapy drug), commonly used in postmenopausal women, may cause

Joint pain.
Bone thinning.
Hot flashes.

These treatments can affect fertility, as Tamoxifen may disrupt menstrual cycles and Aromatase inhibitors suppress estrogen production. You need to discuss fertility preservation before starting therapy if you plan to have children in the future.

I hope this information helps you.

Feel free to ask further queries.

Thank you.