Abstract
In the United States, there are more than 400,000 girls and young women of reproductive-age
with a history of cancer. Cancer treatments including surgery, chemotherapy, targeted
therapy, and radiation can adversely impact their reproductive health. This review
discusses infertility, contraception, and adverse pregnancy and child health outcomes
in reproductive-aged cancer survivors, to increase awareness of these health risks
for survivors and their health care providers. Infertility rates are modestly higher,
while rates of using contraception and using highly effective contraceptive methods
are lower in cancer survivors than in women without a history of cancer. During pregnancy,
preterm births are also more common in survivors, resulting in more low-birth-weight
offspring. Children of cancer survivors do not have more childhood cancers, birth
defects, or chromosomal abnormalities than the general population, with the exception
of families with hereditary cancer. Reproductive risks in survivors depend on cancer
treatment exposures. For example, women with prior abdominal or pelvic radiation have
additional risks of spontaneous abortions, small-for-gestational-age offspring and
stillbirths, while those with prior chest radiation or anthracycline exposures have
higher risks of cardiomyopathy. To help survivors achieve their reproductive goals
safely, family planning and preconception counseling are central to survivorship care.
Keywords
cancer survivor - contraception - fertility - pregnancy - child health
