How to preserve fertility in BRCA1 breast cancer?

Question

Hello doctor,

I hope this communication finds you well. I am writing to you about my 29-year-old daughter, who was just diagnosed with breast cancer at a young age. We just got the results of her cancer genome tests, which showed a BRCA1 mutation. This explains why she got triple-negative breast cancer.

Her oncologist has suggested that she have a double mastectomy and have her ovaries removed as a precaution. She is having trouble making this choice. Our family history is important. My mother died of ovarian cancer when she was 52, and my sister was diagnosed with breast cancer when she was 45.

The genetic counselor also said that any future children would have a 50% probability of getting this mutation. She just finished chemotherapy with Adriamycin and Cytoxan, and she is set to start radiotherapy next month. We are still worried about the chance of the cancer coming back, but her tumor markers are going down, which is good.

She has been having severe hot flashes and mood swings because the medicine has sent her into menopause. The fertility expert proposed extracting eggs before removing the ovaries. However, this treatment is costly, and we are worried that insurance may not cover it.

We would be very grateful for your help with:

Recommended follow-up care when her treatment is finished.
Dealing with the emotional and physical effects of her diagnosis and genetic abnormality.
Making choices about preventive surgery and keeping your ability to have children.

This news has been very hard on our whole family, and we want to make sure she has the finest care and assistance in the future.

Thank you very much for your time and guidance.

Answer 1

Hi,

Welcome to icliniq.com.

I am sorry for the late response. I hope everything is okay with you.

I completely understand how scared and worried you are about your daughter, especially since she was so young when she was diagnosed. I pray that she gets better, stays strong, and recovers safely.

It is important to know that a positive BRCA1 result does not mean the end. There are many ways to prevent and treat the disease. Bilateral mastectomy and bilateral oophorectomy, which lower the risk of cancer, are the best ways to avoid getting it. They can lower the chance of getting cancer to less than 5%.

She can choose active monitoring if she does not want to have surgery. This would mean getting an MRI of the breast and an ultrasound of the abdomen once a year to find any tumors early and allow for timely treatment. But surgery is still the best way to do things overall.

Egg freezing is a great way to keep her fertility up before her ovaries are removed, so she can still have children in the future. She can have surgery now that she has finished treatment. After surgery, breast reconstruction and hormone replacement therapy can help her deal with hot flashes and other menopause symptoms. Most side effects of chemotherapy go away after the treatment is over.

Costs:

Some groups and programs can help with money, and taking part in clinical trials may also help cover the cost of a treatment or process.

Treatment plan:

Finish the chemotherapy.

Surgery that lowers the risk (bilateral mastectomy and oophorectomy).

In the right cases, breast reconstruction and hormone replacement treatment.

Action needed:

If surgery is put off, active monitoring with an MRI of the breast and an ultrasound of the abdomen should be performed once a year.

Having regular follow-up visits as suggested:

I hope this makes sense.

I am here to help you and your daughter through this process, so feel free to get in touch if you have any more questions.

Thank you.