Understanding fertility and breast cancer treatment
In a recent interview, Dr. Anita Wolfer of the Geneva University Hospitals (HUG) shed light on how breast cancer treatment can intersect with a patient’s desire to have children. Treatments that target hormonal pathways can impact fertility, but for younger women, a carefully supervised pause in therapy—about two years in some cases—may be possible to pursue motherhood. This option is not universal, but it offers a window when a woman and her medical team weigh risks and hopes together.
Fertility and cancer treatment: what the data shows
A larger study from the United States followed hundreds of women with breast cancer and found that about 74 percent who wished to become pregnant eventually did so, sometimes with medical assistance. Importantly, the majority of the resulting children were healthy, and there was no clear evidence of a higher risk of cancer relapse linked to the temporary treatment pause. These findings, while context-specific, offer a measure of reassurance for patients and doctors navigating fertility decisions during cancer care.
Breast cancer in younger women: the Swiss context
Across Switzerland, more than 6,600 breast cancer cases are diagnosed each year, with the majority occurring in women over 50. However, younger women are increasingly affected. Dr. Wolfer notes that roughly 5 percent of breast cancers are diagnosed before age 40, amounting to about 300 cases annually in Switzerland. While this remains a minority, the trend has amplified attention to fertility, screening, and tailored care for younger patients.
Screening and the age debate
The discussion around the right age to begin breast cancer screening is lively. Some countries, like Sweden, have lowered the starting age to 40, while the World Health Organization recommends screening beginning at 50, consistent with Swiss practice. In Switzerland, screening guidelines vary by canton, and access can depend on local policies and funding. Dr. Wolfer emphasizes that although many cantons in the Romandy region start at 50, some areas offer limited or no free mammography. The public health priority, she notes, is to ensure reliable access and affordability for women who need it.
Should the screening age be lowered?
Dr. Wolfer cautions against a blanket rule. Mammography alone may not be the most effective screening tool for younger women, who often require additional imaging. The debate hinges on balancing scientific evidence, population risk, and health system capacity. In the meantime, a nuanced approach—considering individual risk factors such as family history and genetic predispositions—appears prudent.
How to tailor screening: a case-by-case approach
For women with a strong family history of breast cancer, earlier screening is commonly recommended. Beyond imaging, genetic or genomic testing from a blood sample can help identify predispositions and guide decisions about when to start screening. Dr. Wolfer highlights that combining family history, lifestyle factors, age at first pregnancy, and alcohol use allows a more precise assessment of an individual’s risk and informs whether to start screening earlier or later.
Towards a more personal approach to care
As breast cancer care evolves, the emphasis is on personalized risk assessment and shared decision-making. For patients, this means candid conversations about fertility preservation options, the risks and benefits of pausing treatment, and realistic expectations about pregnancy outcomes and cancer recurrence. For clinicians, it means integrating fertility counseling, genetic risk assessment, and nuanced screening strategies into routine oncologic care.
Overall, the message from experts like Dr. Wolfer is clear: decisions about fertility, screening, and treatment must be individualized. With careful planning and ongoing research, young women facing breast cancer can pursue life goals, including motherhood, while maintaining strong cancer control and hopeful prospects for the future.
