Breast Cancer Diagnosis for Giuliana Rancic Raises Questions About In Vitro Fertilization
By Sonya Collins
WebMD Health News
Reviewed by Laura J. Martin, MD
Oct. 18, 2011 -- When E! News anchor Giuliana Rancic made her breast cancer diagnosis public, there was speculation about whether fertility treatment might have been a factor.
On NBC's Today show, Rancic, 37, said she got a mammogram when her doctor strongly recommended it before starting another round of IVF (in vitro fertilization). On their reality TV show, Rancic and her husband, Bill, have chronicled their previous fertility treatments.
Rancic's diagnosis has raised questions about whether fertility treatment can increase the risk for breast cancer. WebMD got answers from fertility and breast cancer specialists.
Is there a link between IVF and breast cancer risk?
Fertility and cancer experts interviewed for this story agree that there is no strong evidence to connect fertility drugs with increased risk for breast cancer. Oncologists add that there is a need for studies that follow women who have undergone IVF for longer periods of time.
Couldn't the increased levels of estrogen in fertility treatments increase risk for breast cancer?
Exposure to estrogen and progestin after menopause has been linked to increased risk for breast cancer for women in their 50s and 60s, but fertility drugs do not expose women to estrogen at that age, says Samantha Pfeifer, MD. She is chair of the practice committee at the American Society for Reproductive Medicine.
Pfeifer says fertility drugs raise estrogen levels for up to seven days at a time. "Estrogen levels are not significantly raised for a prolonged period of time."
Is it possible that women undergoing fertility treatment have other risk factors unrelated to fertility drugs?
Yes. There are many factors that affect breast cancer risk.
Most women undergoing fertility treatment are over 32 and have never had a child, which is a risk factor for breast cancer, says Jennifer Litton, MD. Litton is a breast medical oncologist at the University of Texas M.D. Anderson Cancer Center.
Are there special recommendations for women who want to undergo IVF but who have increased risk factors for breast cancer, such as the BRCA gene mutation or a family history?
Recommendations about undergoing fertility treatment are no different for women who have breast cancer risk factors. "As long as you don't have a cancer diagnosis," Litton tells WebMD, "at this point, there is no evidence that IVF will increase risk for patients with greater risk factors, even those with the BRCA gene mutation or family history."
Is it common for fertility doctors to recommend a mammogram before a woman undergoes IVF?
Any woman who is trying to get pregnant should be following the regular guidelines for health maintenance. "You want to make sure the Pap smears are up to date and that any routine screening has been done," Pfeifer says. "We follow the established guidelines of mammograms starting at age 40 for women who don't have significant risk factors."
The guidelines about when to start screening mammograms are also controversial.
Is fertility treatment an option for breast cancer survivors?
"It can be an option, but it depends on several factors," says Eric Widra, MD, who chairs the practice committee for the Society for Assisted Reproductive Technologies.
These factors include a woman's age at the time of treatment because fertility naturally decreases over time, and most oncologists recommend a woman be cancer-free for around five years before trying to get pregnant. Future pregnancy also depends on the damage chemotherapy may have done to a women's reproductive system. It is ideal to see a fertility specialist before beginning cancer treatment rather than after.
"What we often do for our patients, especially if they are over 30, is consider fertility preservation before they go through chemo," Litton tells WebMD, "by retrieving eggs and freezing the eggs or embryos. Freezing embryos is the standard. Freezing eggs is still considered experimental."
SOURCES: Samantha Pfeifer, MD, chair, practice committee, American Society for Reproductive Medicine.Jennifer Litton, MD, breast medical oncology, University of Texas M.D. Anderson Cancer Center, Houston.Eric Widra, MD, chair, practice committee, Society for Assisted Reproductive Technologies. ©2011 WebMD, LLC. All Rights Reserved.