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Risks of cancer treatments to ovarian function
Degree of Risk Treatment Protocol Patient and Dose Factor Common Usage
High Risk >70% amen
Intermediate 30- 70% amen
Lower Risk <30% amen
Any alkylating agent + TBI/pelvic radiation Conditioning for HSCT; sarcoma inc Ewings, ovarian
Total cyclophosphamide dose
Procarbazine: MOPP, BEACOPP
Total cyclophosphamide
nonalkylating agents or lower levels of alkylating (e.g., ABVD, CHOP, COP; leukemia)
Anthracycline + cytarabine
MRC Centre for Reproductive Health at the University of Edinburgh
5 g/m2 age > 40 7.5 g/m2 age <20
5 g/m2 in women age 30- 40
Multiple cancers: breast cancer, NHL, HSCT
Hodgkin lymphoma
Multiple cancers, breast
Hodgkin lymphoma, NHL; leukemia
AML
AC for breast cancer x4 + Paclitaxel or Docetaxel in women Breast age <40
for breast cancer with cyclophos (CMF, Women < 30 Breast CEF, CAF)
Very Low/No Risk
Multi-agent with vincristine Leukemia, Lymphoma
From Loren AW, et al (2013) ASCO clinical practice guideline update. J Clin Oncol 31, 2500-2510
Population-based analysis of pregnancy after cancer
No of women
SIR
95% CI
Cervix uteri
3498
0.34
0.31-0.37
Breast
5173
0.39
0.36-0.42
Brain, CNS
1045
0.42
0.36-0.48
Leukaemia
1077
0.48
0.42-0.54
Ovary
1129
0.63
0.57-0.69
Hodgkin lymphoma
962
0.67
0.62-0.73
Non-Hodgkin lymphoma
673
0.67
0.58-0.77
Thyroid
926
0.79
0.72-0.86
Skin
5252
0.87
0.84-0.90
1981-2012, aged 0-40 23,201 cancer survivors
38% less likely to achieve a pregnancy after diagnosis than women in the general population
28.6% vs 46.4% of women achieve a pregnancy after a cancer diagnosis
MRC Centre for Reproductive Health at the University of Edinburgh
RA Anderson et al 2018 Human Reprod
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