“How long do I have to live and when can I have children?” are two questions most commonly asked by an increasing percentage of women of childbearing age who have been diagnosed with breast cancer. The remarkable level of confidence that women have in pursuing such questions are a reflection of improved breast cancer treatment protocols, heightened concern about cancer survival, and added emphasis on quality of life after cancer treatment.
Today, with a more enlightened approach, the success of cancer treatment is mutually determined by prolonged disease survival coupled with the quality of life in surviving the illness. The incidence of breast cancer is rising dramatically. In 1992, the estimated new cases of breast cancer were 180,000. Roughly, this translates into an incidence of one in every nine women.
Intensive public education programs that highlight the benefits of breast self-examination and improved mammographic screening techniques have led to earlier detection of the disease. The proliferation of breast cancer treatment options and intensive supportive care during cancer therapy have led to longer disease-free survival.
Today, the five-year survival rate for localized breast cancer is 91%. Given these statistics, not only does breast cancer have a high prevalence in American society, but there is also a higher percentage of women who are surviving and living longer with the disease. Yet, there is a paucity of research on breast cancer survivorship. In general, much of the existing data on cancer survivors has been generated from pediatric cancer. Surviving cancer has many facets.
It begins at diagnosis and continues through cancer treatment into the after-treatment periods. Dealing with and managing the acute side effects of cancer treatment are the major tasks during therapy. However, resuming work, establishing friendships, and disclosing one’s diagnosis of cancer, are added issues that cancer survivors face after the assault of the initial cancer diagnosis and subsequent treatment. Apart from surviving the disease, there are specific physiologic, psychological, emotional, spiritual, and existential needs such as work and employment issues, improved quality of life, fertility and reproductive health, fear of disease recurrence and adaptation that are of prime concern for cancer survivors. By the year 2020, it is projected that one out of every 1,000 persons over the age of twenty will be a cancer survivor.
Five percent of all newly diagnosed cancers occur in persons thirty-four years or younger. Based on five percent of the 1,040,000 cases of cancer diagnosed in 1990, then approximately 52,000 patients will be treated for cancer during or before their reproductive years. Undoubtedly, maintaining fertility when one has a history of cancer will be a major concern for cancer survivors.