Fertility and breast cancer: navigating treatment and life plans
In a recent discussion on La Matinale, Dr. Anita Wolfer, associate physician in the Oncology Department at Geneva University Hospitals (HUG), explains how breast cancer treatment—often hormone-based—can affect a patient’s ability to have children. For younger women who wish to conceive, a temporary pause in treatment is sometimes possible, under strict medical supervision.
Wolfer notes that hormonal therapies used to treat hormone receptor–positive cancers may interfere with fertility. However, for selected patients, a carefully monitored pause of about two years can be considered so that pregnancy and parenthood are not foreclosed options. This approach requires close coordination among oncologists, fertility specialists, and the patient to balance cancer control with future family plans.
Evidence on fertility outcomes and safety
She cites an American study of hundreds of women with breast cancer, which found that about 74% who desired pregnancy were able to achieve it. Importantly, most of the resulting children were healthy at birth, and there was no clear evidence of an increased relapse risk associated with the temporary halt in treatment. These findings, while encouraging, are individualized: decisions depend on tumor biology, patient age, and overall health, as well as the feasibility of safe pregnancy timing.
Breast cancer in younger women: an evolving picture in Switzerland
Switzerland registers around 6,600 new breast cancer cases each year. The current pattern shows the majority of diagnoses in women over 50, but the number of younger patients is rising. Dr. Wolfer highlights that roughly 5% of cancers diagnosed in women occur before age 40, translating to around 300 women annually. Alarmingly, breast cancer has become the leading cause of cancer-related death among women under 40 in Switzerland, underscoring the need for tailored strategies for younger patients and risk-aware public health measures.
Age for breast cancer screening: where do we stand?
The discussion about lowering the screening age has gained traction in some countries. Sweden, for example, has lowered the target age to 40 in its screening campaigns. The World Health Organization (WHO) continues to advise starting screening at 50, every two years, which aligns with current Swiss practice. In French-speaking cantons of Switzerland, screening generally begins at 50, but access and cost remain important considerations—mammography isn’t always free in all cantons, according to Wolfer.
Balancing public health and individual risk
Wolfer emphasizes the need to weigh epidemiological data and public health priorities. While there is a push to consider earlier screening for some groups, simply exposing all younger women to mammography and potential follow-up ultrasounds may not be the most efficient or protective approach. A more nuanced strategy considers family history, individual risk factors, and local healthcare capacity. In practice, the case-by-case method often guides screening decisions for younger women.
For women with a strong family history of breast cancer, there is a higher likelihood of starting screening earlier. She also points to advances in risk assessment, including genome analysis via a simple blood test. When combined with family history, lifestyle factors (such as alcohol use and reproductive history), these tools can help tailor the timing of screening to the individual rather than applying a one-size-fits-all rule.
Towards a personalized approach to screening and prevention
According to Wolfer, the challenge is to harmonize scientific evidence with practical public health considerations. The aim is to offer timely and appropriate screening while ensuring equitable access to preventive services and diagnostic tests. As research advances—particularly in fertility preservation, safer pregnancy after cancer, and genetic risk profiling—the Swiss healthcare system may increasingly adopt risk-based screening that reflects a person’s unique profile rather than age alone.
In sum, the dialogue around fertility in young breast cancer patients and the optimization of screening for younger women is evolving. Dr. Anita Wolfer’s insights highlight both the hope for preserving family dreams after cancer and the ongoing work to refine screening guidelines in light of rising incidence among younger women.
