Issues for People at Risk
A recent study published in the leading cancer journal, Journal of Clinical Oncology concluded that mutations in the BRCA1 gene may lead to early diminishment of egg reserve. This finding may, at least in part, explain why infertility is associated with breast and ovarian cancer risks, similar to women with BRCA mutations. The study concluded that there is an association between low response to ovarian stimulation with fertility drugs and BRCA1 mutations. Genetic counseling and testing in women with infertility and low response to ovarian stimulation may be worthwhile, especially when there is family history of breast and/or ovarian cancer. Larger studies are warranted to further investigate the link between BRCA mutations and fertility and improve fertility options for BRCA carriers.
Very little has been written on the safety of fertility medication and in-vitro fertilization in people with a BRCA mutation or hereditary cancer risk. At our 2007 annual conference, in his session on "External and Environmental Modifiers of Cancer Risk" Dr. Steven Narod presented on the effects of different fertility medications on cancer risk in BRCA carriers. You can view a free webcast from the session.
Preimplantation Genetic Diagnosis (PGD) is a medical procedure that allows people who carry a disease-causing hereditary mutation to have children who are free from the specific mutation that causes the disease.
The procedure for PGD includes in-vitro fertilization (IVF)—a fertility treatment where the women’s eggs are removed and fertilized in a test tube. When the embryos reach a certain size, one cell is removed and is tested for the hereditary disease in question. Once the genetic status is determined, the parents can decide which embryos they want implanted.
PGD has been used for hereditary diseases such as cystic fibrosis and Huntington’s disease for over a decade. Recently, there has been some debate among the medical community regarding its use for selecting embryos free of gene mutations such as BRCA1/2. Central to this debate is the issue of whether or not this procedure should be used for mutations such as BRCA which don’t cause cancer until adulthood, where not everyone who carries the trait will get cancer, and where there are options available for preventing cancer (such as chemoprevention and surgery).
Researchers from Moffitt Cancer Center in Tampa teamed up with FORCE to survey FORCE members about their knowledge of and attitudes about PGD. Results from the survey are reported in an article published in the Journal Fertility and Sterility. The Spring 2008 edition of Joining FORCEs, the FORCE newsletter has an article that summarizes the study and it's results.
Whether you are a cancer survivor or previvor, adoption is a wonderful way to create or expand a family. There are many reputable professionals, agencies and organizations available for education and support. The Summer/Fall edition of Joining FORCEs has two articles related to adoption. "Courtney's Adoption Story" tells one members journey through adoption after breast cancer. The accompanying commentary has information on types of adoption and adoption resources.
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