To outline the risks of infertility from breast cancer treatment, and to illustrate current techniques in preserving fertility in breast-cancer patients who wish to become pregnant after treatment is concluded.
Breast cancer often affects women of reproductive age. Although treatment is effective, cytotoxic chemotherapy causes ovarian reserve depletion, whereas hormonal therapy necessitates a delay in pregnancy, resulting in infertility. Patients of reproductive age should be referred to fertility specialists to explore methods of fertility preservation upon diagnosis. The best established method of fertility preservation is embryo cryopreservation, although investigational techniques such as, oocyte and ovarian tissue cryopreservation, may hold potential. Embryo cryopreservation involves ovarian stimulation to retrieve oocytes in-vitro fertilization prior to freezing. Techniques for the cryopreservation of unfertilized oocytes are under investigation. Successful pregnancies have resulted in breast cancer patients after treatment, without obvious compromise in their risk of recurrence or death from breast cancer.
Ovarian stimulation with retrieval of ooctyes for in-vitro fertilization remains the best known option for fertility preservation in women with early stage breast cancer whose risk of fertility may be compromised by adjuvant chemotherapy.
"Fertility preservation is an increasingly urgent issue for female cancer survivors (Backhus et al., 2007; Dunn and Fox, 2009; Hulvat and Jeruss, 2009; Johnston and Wallace, 2009; Maltaris et al., 2009; Peate et al., 2009; Jeruss and Woodruff, 2009; Woodruff, 2009; van der Kaaij et al., 2010; Gardino et al., 2010). This is also due to rapid advances in reproductive technologies (Maltaris et al., 2008; West et al., 2009). "
[Show abstract][Hide abstract] ABSTRACT: Cells experiencing DNA damage undergo a complex response entailing cell-cycle arrest, DNA repair and apoptosis, the relative importance of the three being modulated by the extent of the lesion. The observation that Abl interacts in the nucleus with several proteins involved in different aspects of DNA repair has led to the hypothesis that this kinase is part of the damage-sensing mechanism. However, the mechanistic details underlying the role of Abl in DNA repair remain unclear. Here, I will review the evidence supporting our current understanding of Abl activation following DNA insults, while focusing on the relevance of these mechanisms in protecting DNA-injured germ cells. Early studies have shown that Abl transcripts are highly expressed in the germ line. Abl-deficient mice exhibit multiple abnormalities, increased perinatal mortality and reduced fertility. Recent findings have implicated Abl in a cisplatin-induced signaling pathway eliciting death of immature oocytes. A p53-related protein, TAp63, is an important immediate downstream effector of this pathway. Of note, pharmacological inhibition of Abl protects the ovarian reserve from the toxic effects of cisplatin. This suggests that the extent of Abl catalytic outputs may shift the balance between survival (likely through DNA repair) and activation of a death response. Taken together, these observations are consistent with the evolutionary conserved relationship between DNA damage and activation of the p53 family of transcription factors, while shedding light on the key role of Abl in dictating the fate of germ cells upon genotoxic insults.
[Show abstract][Hide abstract] ABSTRACT: Circa il 2% dei tumori maligni si sviluppa nei primi 18 anni di vita. Nei Paesi occidentali ogni anno un bambino ogni 500,
più o meno ugualmente distribuiti nei due sessi, si ammala di tumore. In generale, nel bambino la neoplasia più frequente
è rappresentata dal gruppo delle malattie del sangue, comprendente leucemie e linfomi (45%), seguito da tumori del sistema
nervoso centrale (22%), neuroblastoma (7%), sarcomi dei tessuti molli (7%) e tumori ossei (6,4%); le percentuali variano ulteriormente
secondo la fascia d’età.
[Show abstract][Hide abstract] ABSTRACT: Resumen La fertilidad es un aspecto importante en las mujeres jóvenes con cáncer de mama (CM). El 25% de las mujeres con CM son premeno-páusicas al diagnóstico. La toma de decisiones sobre la fertilidad en estas mujeres es compleja y de suma importancia para su futuro como madres. La quimioterapia adyuvante es un trata-miento empleado muy frecuentemente en mujeres pre-menopáusicas con CM debido al benefi cio demostrado en términos de super-vivencia. La quimioterapia induce amenorrea (AIC). La incidencia de AIC esta relacionada con la edad de la paciente, el fármaco, las dosis y el número de ciclos empleado. En es-tas mujeres, además del impacto que supone el diagnóstico del cáncer su pronóstico y la información sobre el tratamiento, se asocian otros aspectos a los que deben hacer frente, destacando la pérdida de la fertilidad. Cuando administramos tratamiento quimioterápico, no debemos olvidar la preservación de la función ovárica. Entre los procesos aun experimenta-les empleados para ello se encuentra la crio-preservación de embriones y de ovocitos y la preservación de la corteza ovárica. Dada su importancia, la fertilidad tras el tratamiento debe ser discutida antes del inicio del mismo, aplicando un modelo de atención en el que la paciente después de haber recibido la infor-mación necesaria, pueda tomar una decisión respecto a su futuro como larga superviviente de cáncer en el que se contemple la fertili-dad. Pueden existir características, de la propia enfermedad o del medio, que no permitan al Abstract Fertility it's an important issue in breast cancer (BC) patients. Twenty-fi ve percent of the patients with BC are premenopausal at diagnosis, Decision-making about fertility in young women with BC, is complex and ex-tremely important for their future as mothers. Adjuvant chemotherapy is extensively used in premenopausal patients because of its overwhelming benefi cial affects of outcome. Chemotherapy induces amenorrhea (CIA). The incidence of CIA, it's in relation with the patient age, drug, dose and number of cycles In addition to considerations related to presentation of disease, prognosis, and treatment, young women with BC faces various problems, one of them it is their fertility. When chemotherapy is indicated the preservation of ovarian function should be considered. Experimental procedures to retain fertility after BC by cry preservation of unfertilized eggs or embryons or ovarian tissues are now on study. As is a very important question for BC young women, fertility after treatments for BC should be discussed before planning of adjuvant therapies It should be based on a model of attention where the patients could take an informed decision as a cancer long survivor about their fertility .The oncologist could have problems to offer the possibility to preserve the patients fertility, and also the patients can have same personal problems that make diffi cult to take this decision.. This work describes the different medical options, aspects of communication and psychological ways that mediate this entire process.
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