Pass It Forward: Fertility After Pediatric Cancer

Years ago, a female friend was diagnosed with breast cancer weeks before her wedding. Her fertility was uncompromised, so a year or two after a double mastectomy, she remained determined to have children. Her first baby was a boy. No problem. Before her second child was born, she shared with us that she feared having a girl because she didn’t want to go through what her mother had suffered through with her, that is a daughter who contracted breast cancer. Our friend did give birth to a female.  Davida is still young, in her third year of college, and to our knowledge she has not yet been tested for the breast cancer gene.

            In an article on the New York Times blog, “After Cancer, Fertility is Often Within Reach,” a 39-year-old working mother, Karen Cormier, revealed that after developing a “rare form of kidney cancer” at age 5, she assumed she wouldn’t be able to become pregnant due to her doctors’ counsel that the treatments damaged her reproductive organs. Three years after adopting a child, Ms. Cormier became pregnant and had Ryan, “a walking biological miracle.”

            The Times blog post makes the point that many adults who survive childhood cancer struggle to conceive, especially if they had received pelvic radiation treatments, a certain class of chemotherapy drugs, high doses of radiation, or stem cell transplants. After the two latter treatments these youthful patients became completely sterile. Nowadays, though, fertility treatments for both male and female childhood cancer survivors increase their chances of overcoming clinical infertility, leading doctors to surmise that young patients’ ovaries and testes may be more resilient than originally believed.

           Cancer trade magazine According to the Times article, a recent large study in The Lancet Oncology found that about two out of three female survivors who turned to fertility treatments did become pregnant – “a rate of success that mirrored the rate among other infertile women.” Other recent studies found that many adult men with low sperm counts after having childhood cancer (due to side effects of chemotherapy) “undergo procedures that harvest viable sperm, allowing them to father their own children.”

            Although this article holds out hope for many would-be parents who had pediatric cancer, it fails to mention the possible consequences for their biological children, specifically, what about the hereditary cancer that parents with their own early history of the disease might pass on to their child?  

            According to the American Cancer Society, only about 5 percent to 10 percent of all cancers are inherited.  In spite of this low percentage, “cancer in a close relative like a parent or sibling . . .  is more cause for concern than cancer in a more distant relative.”  Also, a family member that had a very early onset or rare cancer should consult with a genetics specialist for their children’s sakes.  

            Due to the widespread media coverage of Angelina Jolie’s recent double mastectomy, many Americans have become aware of

Angelina Jolie inherited her mother's predisposition for breast cancer.

Angelina Jolie. Photo courtesy Georges Biard

some women’s predisposition for breast and ovarian cancers. Had Jolie had genetic testing a few years earlier, she might have decided against having biological children. Indeed, her daughter Shiloh, with a grandmother who had contracted breast cancer and a mother who carried the gene for same, is most probably at high risk for the illness.

            Over the years, in some of Cheryl’s conversations with would-be parents about adoption, many expressed a concern that if the adoption isn’t “open,” meaning that if the biological parent isn’t in the picture (and/or cannot be reached), the adopted child’s unknown health and psychological history could lead to serious medical problems. Yet, some of these same would-be parents seem willing to pass an inherited illness like cancer onto their own biological child!

            So, here’s the message to doctors who specialize in fertility, and to would-be parents who suffered from childhood cancer but yearn to have biological offspring: Think twice before making children. The genetics you pass along may be dangerous for the kids.

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