Dr Ra­jen Ram­paul

Breast and On­coplas­tic Sur­geon

Pink Hi­bis­cus Breast Cen­tre

Med­i­cine and imag­ing have made ex­po­nen­tial strides in the man­age­ment of breast can­cer. Con­se­quent­ly, the treat­ment land­scape for women with this dis­ease has been rev­o­lu­tion­ary. Once di­ag­nosed ear­ly, women to­day can look for­ward to a pos­i­tive life tra­jec­to­ry. As a re­sult, it is not un­com­mon for me to see young women di­ag­nosed with breast can­cer in my prac­tice.

Trinidad has one of the high­est in­ci­dences of breast can­cer among young women, as demon­strat­ed in re­search we have con­duct­ed. The me­di­an age of di­ag­no­sis in Trinidad is far low­er than that of the Unit­ed King­dom, mean­ing that our pa­tients are of­ten not on­ly younger but al­so fac­ing more ag­gres­sive forms of the dis­ease. Be­ing di­ag­nosed at a younger age car­ries unique im­pli­ca­tions. From a prog­nos­tic stand­point, these women must con­tend with the dis­ease for a longer pe­ri­od of their lives. Be­yond sur­vival, how­ev­er, they al­so face per­son­al and so­cial chal­lenges that are less promi­nent lat­er in life.

Com­mon con­cerns for this group in­clude start­ing a ca­reer, find­ing a part­ner, build­ing re­la­tion­ships, en­ter­ing mar­riage, and, very im­por­tant­ly, start­ing a fam­i­ly. Many young women with breast can­cer have not yet had chil­dren but deeply de­sire to do so. The wish to be­come a moth­er is a vi­tal and ful­fill­ing part of life, and a breast can­cer di­ag­no­sis can make this dream feel un­cer­tain.

Surgery for breast can­cer does not pre­vent a woman from be­com­ing preg­nant, though it may af­fect her abil­i­ty to breast­feed. De­pend­ing on the ex­tent and type of surgery, the breast may no longer be able to pro­duce or car­ry milk ef­fec­tive­ly. A greater con­cern, how­ev­er, lies with ad­di­tion­al treat­ments—par­tic­u­lar­ly chemother­a­py—which can dam­age the ovaries and halt egg pro­duc­tion, there­by af­fect­ing fer­til­i­ty.

It is there­fore es­sen­tial that fer­til­i­ty coun­selling be­comes an in­te­gral part of pa­tient ed­u­ca­tion be­fore start­ing ad­ju­vant treat­ments such as chemother­a­py. Pa­tients should be clear­ly in­formed that chemother­a­py may re­duce their chances of a vi­able preg­nan­cy. For­tu­nate­ly, there are sev­er­al op­tions avail­able for fer­til­i­ty preser­va­tion af­ter breast can­cer treat­ment. Ide­al­ly, dis­cus­sions about these op­tions should take place be­fore surgery and cer­tain­ly be­fore chemother­a­py be­gins.

One ap­proach com­mon­ly used in my prac­tice is to tem­porar­i­ly sup­press ovar­i­an func­tion with med­ica­tion pri­or to chemother­a­py. This ef­fec­tive­ly “puts the ovaries to sleep”, al­low­ing chemother­a­py to pass with­out caus­ing sig­nif­i­cant harm to the eggs. The treat­ment halts the mat­u­ra­tion of eggs and re­lat­ed hor­mones tem­porar­i­ly, of­fer­ing some pro­tec­tion to ovar­i­an func­tion.

An­oth­er vi­able op­tion is egg har­vest­ing and freez­ing pri­or to chemother­a­py. These pre­served eggs can lat­er be fer­tilised and reim­plant­ed, giv­ing women the op­por­tu­ni­ty to achieve preg­nan­cy and car­ry it to term.

While this ar­ti­cle does not in­tend to pro­vide a com­pre­hen­sive overview of fer­til­i­ty preser­va­tion, it aims to raise aware­ness that young women with breast can­cer should not view their di­ag­no­sis as the end of their hopes for moth­er­hood. With the right ad­vice, plan­ning, and mul­ti­dis­ci­pli­nary care, much can be done to safe­guard their fu­ture fer­til­i­ty.

It is cru­cial that doc­tors ini­ti­ate these con­ver­sa­tions ear­ly—ide­al­ly be­fore surgery—so that pa­tients have the time and in­for­ma­tion need­ed to make in­formed de­ci­sions about their fam­i­ly plan­ning. Ad­dress­ing these con­cerns with­in a team that in­cludes a fer­til­i­ty ex­pert can make an enor­mous dif­fer­ence. In my ex­pe­ri­ence, such dis­cus­sions are deeply ap­pre­ci­at­ed by pa­tients and con­tribute sig­nif­i­cant­ly to their emo­tion­al well-be­ing.

In many ways, this holis­tic ap­proach im­proves how pa­tients view their lives be­yond breast can­cer. It em­pow­ers them to en­vi­sion a fu­ture where they not on­ly sur­vive but thrive—beat­ing can­cer, rais­ing beau­ti­ful chil­dren, and con­tin­u­ing the cy­cle of life. Ul­ti­mate­ly, that abil­i­ty to give life is one of the most mean­ing­ful vic­to­ries of all.