Miriam Falco – CNN Medical Managing Editor
October 18, 2011
E! News anchor Giuliana Rancic’s efforts to conceive have been the main theme of her reality show “Giuliana and Bill.” On Monday she revealed she has to postpone her next round of IVF after her new fertility expert insisted she get screened for breast cancer, even though she is only 36 years old.
Rancic said, on the Today Show, that her doctor told her “I don’t care if you’re 26, 36. I won’t get you pregnant if there is a small risk you have cancer. If you get pregnant it can accelerate the cancer. The hormones accelerate the cancer.”
Her doctor may have been taking the step as a precaution.
“There’s no evidence for a link between breast cancer and infertility treatment,” says Dr. Eric Widra, who chairs the Society for Assisted Reproductive Technology. A 2005 study looked at a possibility but the study authors concluded a link to breast or ovarian cancer had not been found.
Dr. George Sledge, co-director of breast cancer treatment at Indiana University’s Simon Cancer Center, says there are no good data to show that IVF accelerates breast cancer. “Not having a child and infertility in itself increases the risk for breast cancer,” he says. Sledge isn’t familiar with Rancic’s medical history, but he says the younger you are when you have your first child, the less likely you are to have breast cancer.
“Breast cancer at 36 is rare, and it’s fortunate for her that it was detected early,” says Widra, a physician at Shady Grove Fertility in Washington, D.C. However, he doesn’t agree with Rancic’s doctor that women in their 20s or 30s should get a mammogram before starting IVF. The American Society for Reproductive Medicine recommends the same guidelines as the American College of Obstetrics and Gynecology, he says: Begin screening at the age of 40, unless there’s family history.
But it appears things can vary from clinic to clinic. Dr. Andrew Toledo, a fertility specialist at Reproductive Biology Associates in Atlanta, says in his clinic, “We want a baseline mammogram [for our patients] between 35 and 40, unless they have a family history.”
Rancic had previously undergone two rounds of IVF. The second did result in a pregnancy, which ended in a miscarriage. She says she plans to try to get pregnant again after having surgery this week and undergoing six weeks of radiation treatment.
Sledge, who is the past president of the American Society of Clinical Oncologists, says the use of estrogen in general in women who’ve had breast cancer makes doctors nervous because some cancers are fueled by hormones.
But Widra says women who have successfully completed their cancer treatment can try to get pregnant again, typically five years after they have been disease-free. Widra, who is not familiar with Rancic’s specific case, points out that even after surgery and radiation, breast cancer patients may need to undergo even more treatments, like taking the drug tamoxifen, which can reduce the risk of breast cancer coming back by blocking the activity of estrogen in the breast if the breast cancer is fueled by estrogen – not all cancers are.
When a woman tries to get pregnant after undergoing breast cancer, her treatment needs to be individualized, says Dr. Mitch Rosen, director of the Fertility Preservation Center at the University of California-San Francisco. He says he sees many patients facing this question and he says it’s incredibly important that women receive good counseling. “It depends on your cancer, your age, what kind of cancer you have,” he says. If a woman has the type of tumor that is fueled by estrogen, tamoxifen (or other hormone-disrupting drugs) need to be taken for five years.
If a cancer patient is 22, Rosen says he would recommend she wait the full five years before trying to get pregnant. If she’s 38, for example, getting pregnant gets harder with age – then, he says, he would probably recommend taking the hormone-blocking medication for tw0 years, taking a break to get pregnant, and then resuming the drug for three more years.
If a patient has a type of cancer that is not dependent on hormones to grow, then surgery and radiation are usually followed by chemotherapy to kill any lingering cancer cells.
In those cases, Rosen says he recommends that his patients wait at least six months, better a whole year, before trying IVF again, just to reduce the possibility of birth defects caused by the cancer treatment.
Patients need to talk to their doctor and be made aware of the risks and options, so they can be comfortable with their decision on when and whether they should undergo IVF again.