Today, as millions of men and women of childbearing age and younger are surviving cancer, the question of reproduction is arising as a paramount consideration in planning treatment. 46)Among the issues are the ability to preserve fertility while curing, the disease and the safety of pregnancy for both mothers with cancer and their future children.
In a continuing study of more than 20,000 survivors of childhood cancers, the two greatest concerns mentioned by former patients two and three decades later are "Can I have children?" and "If I have children, will they be healthy?" said Dr. Leslie Robison, an epidemiologist(流行病学)at the University of Minnesota Medical School, who directs the project involving 25 cancer centers. 47)"Today more than 75 percent of children with cancer are being cured, yet we know little about the side effects of treatment beyond the first 10 years."
While some cancer treatments-drugs as well as radiation-can cause sterility(不育)or reduced fertility(生育能力)in men and women, preliminary evidence suggests that cancer therapy, in general, affects the ability to reproduce and to produce healthy children less than previously thought. 48)At the same rime? new ways are being devised to reduce the effects of cancer treatments on fertility and on pregnancies already in progress when a cancer is discovered.
In the. first report on reproductive issues from the 25-center study, soon to be published in The American Journal of Obstetrics and Gynecology, the researchers found that while higher rates of miscarriage(流产)and lower birth weights were observed among the offspring of former patients, "there are a large number of live births, births of healthy children, a lack of congenital (先天的)abnormalities and very low cancer rates," Dr. Robison said.
Dr. Giuseppe Del Priore, direct6r of gynecologic oncology(妇产科肿瘤学) at Bellevue Hospital in New York, and his colleagues at the New York University School of Medicine noted in the January issue of Contemporary Ob/Gyn: 49)"Less than a generation ago, reproductive-aged women with cancer generally had little to hope for and even less to look forward to. But things have changed. Many cancers are no longer a death sentence. More and more women with cancer are now becoming pregnant and raising legitimate fertility concerns."
Today, a doctor could tell Ms. Zea of Minnesota and other women like her that pregnancy is no longer ill-advised. 50 )Even women whose breast cancers are discovered during pregnancy should no longer be advised to terminate the pregnancy, because there are no data indicating a therapeutic benefit from such an abortion, the New York experts said.
The estrogen(雌激素)produced m pregnancy is weaker than estrogen produced in other women and is less likely to stimulate breast cancer growth, even if the woman's tumor is estrogen-sensitive.