Overview: Fertility and breast cancer treatment
In a discussion on La Matinale, Dr. Anita Wolfer, a senior oncologist at the Geneva University Hospitals (HUG), explains a key nuance for younger women diagnosed with breast cancer: therapies that target hormones can suppress fertility. Yet, for those who wish to start a family, a carefully monitored pause of about two years may be possible, under strict medical supervision. This option is not universal, but it reflects how fertility considerations are increasingly integrated into cancer care decisions.
Pregnancy after cancer: the 74% finding
Dr. Wolfer references a U.S. study involving hundreds of breast cancer patients who pursued pregnancy. In about 74% of cases, the desire to conceive materialized—sometimes with medical assistance. Most resulting births were healthy, and follow-up showed no significant increase in cancer relapse linked to the temporary halt in treatment. While hopeful, these findings highlight the need for individualized risk assessment and ongoing oncologic monitoring when fertility goals influence treatment timing.
Fertility preservation and treatment planning
When hormonal therapies are part of breast cancer treatment, preserving fertility becomes a collaborative decision among patients, oncologists, and fertility specialists. Options may include delaying pregnancy during adjuvant therapy, employing ovarian suppression strategies, or freezing eggs or embryos before treatment begins. A two-year pause is a context‑dependent approach, suitable for early-stage disease with favorable prognosis and where the benefits of motherhood are weighed against the cancer risk. Survivors should discuss fertility timelines early in the care pathway to map out viable options.
The Swiss picture: under-40 breast cancer and screening debates
Switzerland records about 6,600 new breast cancer cases each year, with the majority in women over 50. However, incidence among younger women is rising, and breast cancer has become the leading cause of death among women under 40. Dr. Wolfer notes that roughly 5% of breast cancers are diagnosed in women under 40, equating to about 300 cases annually in the country. This trend underscores the importance of both fertility planning for young patients and age-specific public health strategies.
Screening age: 40 or 50?
The question of when to begin routine breast cancer screening is debated. Some countries, including Sweden, have lowered the screening age to 40. The World Health Organization continues to recommend starting at 50 with biennial screening in many settings, including Switzerland. In the cantons of Suisse romande, screening often starts at 50, and cost remains a barrier where mammography is not fully funded. A family history of breast cancer can justify starting screening earlier, reflecting a risk-tailored approach.
Approach for younger women
Screening for women under 40 is not straightforward: mammography is less sensitive in dense breasts, and additional imaging may be needed. Dr. Wolfer advocates an approach grounded in epidemiology and health policy—assessing risks, costs, and feasibility on a case-by-case basis rather than enforcing a universal rule. While prevalence among under-40s remains relatively low, the question remains: should screening begin earlier for those with higher risk?
Personalized risk assessment and future directions
Beyond age thresholds, genetic testing and risk stratification— via blood tests—can help identify predispositions to breast cancer. When combined with family history, lifestyle factors, age at first pregnancy, and alcohol consumption, these tools can refine when screening starts for an individual. The overarching aim is to align prevention, early detection, and fertility considerations within patient-centered care.
Conclusion: Hope, while balancing evidence
The interview with Dr. Wolfer emphasizes two hopeful threads: that many young breast cancer survivors can pursue motherhood through careful planning, and that screening policies should reflect epidemiology, patient access, and cost realities. As science advances, the path forward rests on personalized care that respects a woman’s fertility goals while managing long-term cancer risk, alongside pragmatic public health decisions about when and how to screen.
