Supporting Your Partner Through Breast Cancer: Navigating Fertility & Sexual Health

A breast cancer diagnosis can shake a young woman’s world. Suddenly there’s an overwhelming flood of information to process, decisions to make, and treatments to face.  For younger women with breast cancer, fertility is often a major concern [1]. Some may worry about how their concerns could upset their partner, while others fear being rejected when forming new relationships [2]. In contrast, older breast cancer patients may be less concerned about fertility if they’ve already had children or decided not to have any before their diagnosis [3].  Emotional Support Makes All the Difference Watching someone you love go through a cancer diagnosis is tough, and it’s normal to feel uncertain about how to be there for them. An important way to support them is to be present, listen without judgement, and create a safe space where they can freely express emotions and voice out concerns [4]. Support from loved ones and health providers can help reduce the stress of a cancer diagnosis [5].  Your loved one might feel frustration or anger at their diagnosis, and may sometimes direct these feelings at you. This can hurt, but it’s important to remember that your partner is upset at their condition, not with you [4]. Your presence and patience matter, even when you feel lost.  Navigating Fertility Concerns Together In addition to emotional support, addressing practical concerns about fertility can help your partner feel supported. If having children is important to both you and your partner, it’s crucial to speak to the doctor before starting treatment. Here are some common questions you might have as a partner: Will breast cancer treatment affect my partner’s ability to become pregnant in the future? Every patient’s cancer is different, so treatment plans are personalised based on individual needs and preferences. While procedures like surgery may not affect fertility, treatments like chemotherapy may affect ovarian function and hence fertility [6]. Can fertility be preserved during treatment? Fertility preservation may be possible. This process saves or protects your loved one’s embryos, eggs or ovarian tissue so they can be used to have children in the future [7]. Options may include [8]: Embryo freezing and In vitro fertilisation: Eggs are removed and fertilised with sperm in a lab, creating an embryo that is frozen and stored for later use. Egg freezing: Eggs are collected and frozen. This method may be used if a woman does not have a male partner and is not keen on using donor sperm.  Ovarian tissue freezing: Ovarian tissue is surgically removed and frozen in a process called cryopreservation. The tissue is reimplanted after treatment. If the tissue begins working normally again, the ovaries may produce eggs, allowing you and your partner to naturally try for a baby.  As a couple, it’s important to remember that while these options offer opportunities to try for children post-treatment, they may not always result in pregnancy. Should we be on birth control during her treatment? Women are advised to avoid getting pregnant during breast cancer treatment, as it can complicate treatment and risks abnormalities to the unborn baby. Discuss with your loved one’s doctor about suitable birth control options and explore what’s best for your situation. In principle, since breast cancer is often related to hormonal activity in the body, hormone-based contraception such as birth control pills will not be advisable. Instead, barrier contraception such as a condom or cap is preferred. [9] [10]. After her treatment, how soon can we try for pregnancy? In general, doctors may advise waiting at least two years after completing treatment to get pregnant, due to worries about cancer recurrence [11] [12]. The wait time can vary depending on the type of cancer and stage, the treatment received and age [13]. Some hormones that increase during pregnancy can potentially cause breast cancer cells to grow, and undergoing cancer treatment during pregnancy can be complex [13].  Are there risks to the baby if my partner becomes pregnant post-treatment? A history of breast cancer has been linked to complications such as low birth-weight, early birth and the need for a caesarean section. However, research has not found that a woman’s past breast cancer has direct effects on the baby, such as birth defects or long-term health concerns [14] [15]. However, medications such as Tamoxifen (which has to be taken for several years), can cause harm to the developing foetus. Hence, precautions to avoid pregnancy should be taken when receiving Tamoxifen treatment.  Will a future pregnancy put my partner at risk of breast cancer recurrence? Since breast cancer is a hormone-driven disease, and pregnancy increases hormone levels, it’s understandable to worry about cancer coming back, particularly those with hormone-positive breast cancer [16]. However, studies have not shown that pregnancy increases the risk of cancer returning. In most cases, pregnancies are generally considered safe for the mother [15] [16].  A recent large study suggested interrupting hormone therapy for pregnancy did not worsen the outcome of breast cancer [17]. However, as individual cancer risk varies, this will have to be discussed with the oncologist.   Open conversations and gathering as much information as possible can offer you and your partner clarity and reassurance. With something as life-altering as breast cancer, making informed decisions will help you move forward together with confidence.  Sexual Health and Intimacy: Braving New Challenges While addressing your partner’s fertility concerns is important, it’s also vital to consider the emotional and physical changes that can affect intimacy and sexual well-being. Sexual health concerns are also common and distressing for women after a breast cancer diagnosis [18]. Physical changes, particularly after surgeries like a mastectomy, can affect how some women feel about their bodies. Treatments that affect hormone levels like chemotherapy and hormone therapy may impact your partner’s sexual interest [19]. Mental strain and fatigue from treatment can also make intimacy challenging.  As their partner, you can help by being sensitive to these changes and communicating openly to avoid misunderstanding. If you’re worried about causing hurt or discomfort, let them know. Ask how your partner feels and respect their boundaries. Intimacy does not always have to be sexual, it can be small gestures like hugging or simply being close to each other [4].  While navigating these changes can be challenging, it can also present new ways to stay connected and grow as a couple.  Navigating breast cancer and its impact on fertility and sexual health can be challenging for any couple. It’s normal to feel overwhelmed by the uncertainty, but speaking with health professionals and leaning on loved ones can make the journey less daunting. Remember, you and your partner are not alone, and with patience and understanding, you can both face it and emerge stronger together.  Article reviewed by Dr Tan Yah Yuen, Senior Consultant and Breast Surgeon at Solis Breast Care & Surgery. References [1] Prevalence and impact of fertility concerns in young women with breast cancer.  [2] Talking but not always understanding: couple communication about infertility concerns after cancer  [3] Prospective Study of Fertility Concerns and Preservation Strategies in Young Women With Breast Cancer  [4] Breast Cancer Now, My partner has breast cancer  [5] Breast Cancer: Exploring the Facts and Holistic Needs during and beyond Treatment  [6] National Breast Cancer Foundation Inc., Does Breast Cancer Treatment Affect Fertility?  [7] American Cancer Society, Preserving Your Fertility When You Have Cancer (Women)  [8] Cancer Research UK, Preserving Fertility and Breast Cancer  [9] Cancer Council Australia, Cancer Fertility Preservation  [10] NHS, Contraception and pregnancy during cancer treatment: Information for patients  [11] Breastcancer.org, Fertility and Pregnancy After Breast Cancer  [12] Breast Cancer Now, Planning pregnancy after breast cancer treatment [13] American Cancer Society, Having a Baby After Cancer: Pregnancy  [14] American Cancer Society, Pregnancy After Breast Cancer  [15] Breastcancer.org, Pregnancy Is Safe After a Breast Cancer Diagnosis, Study Shows [16] Safety of pregnancy after breast cancer in young women with hormone receptor-positive disease: a systematic review and meta-analysis  [17] Interrupting Endocrine Therapy to Attempt Pregnancy after Breast Cancer  [18]  Women's insights on sexual health after breast cancer (WISH-BREAST) [19] American Cancer Society, Body Image and Sexuality After Breast Cancer
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Keyhole Mastectomy : the Key to the Future?

A recent study compared two types of mastectomies: the conventional nipple-sparing mastectomy (NSM) and keyhole methods (using endoscopic or robotic approaches) [1] Conducted across five tertiary hospitals in Taiwan, the study involved 73 conventional NSM cases and 160 keyhole NSM of which 84 cases used endoscopic approach and 76 cases with robotic assistance. Here’s what it revealed about the pros and cons of these methods. What Are Keyhole Surgeries? Keyhole surgeries, also known as minimal access surgeries, involve making small incisions and using specialised long thin instruments e.g. a wand-like camera to assist with the procedures. These methods are common in abdominal and pelvic keyhole surgeries, where they have revolutionised care by reducing post-operative pain, recovery times and complications[2]. In breast surgery, however, keyhole approaches are still evolving and has not replaced the conventional NSM as the standard of care. Study Findings: How Do These Approaches Compare?  The study revealed several key points[1]: Surgery Time and Recovery: All approaches had similar operating times and recovery periods. In skilled hands, keyhole methods could be faster. Wound Healing: Smaller scars (4 cm vs. 9 cm) and better healing were observed in keyhole surgeries, with fewer cases of delayed healing. Complications: All approaches had low complication rates, and overall safety was similar. Patient Satisfaction: Patients in all groups reported high satisfaction with their results, including psychosocial and physical well-being, for instance skin sensation, arm function and minimal or no chronic pain. Costs: Robotic surgeries were more expensive than conventional and endoscopic methods. To date, conventional mastectomy remains the standard of care due to the following reasons: Easier Accessibility and Surgeon Expertise: Conventional mastectomy is widely accessible because it does not require specialised equipment like robotic and endoscopic systems, making it suitable for hospitals with limited resources. Most surgeons are already familiar and experienced in the conventional approach: ensuring reliable and consistent results. Comprehensive Cancer Removal for Complex Cases: The conventional approach offers direct access, visualisation and tactile appreciation of the surgical site, enhancing the surgeon’s ability to ensure complete cancer removal. This makes it particularly effective for complex cases, such as advanced or multifocal cancers, where extensive tissue removal is necessary to ensure oncologic safety. Simplified Reconstruction Options: The larger incision in conventional NSM allows easier access for various immediate breast reconstruction options, providing more surgical flexibility in terms of reconstructive options Proven Long-Term Outcomes: With a long-established track record, conventional mastectomy has demonstrated consistent effectiveness and safety in breast cancer treatment. Cost-Effectiveness and Lower Maintenance Costs: Conventional NSM costs less than robotic or endoscopic surgeries, as it avoids the additional and often high costs of advanced equipment. Hospitals also benefit from reduced maintenance expenses, further enhancing its cost-effectiveness. Versatility Across Patient Profiles: Conventional NSM is highly adaptable, making it suitable for a wide range of patients, including larger advanced cancers involving skin, the patient’s physical habitus or unique anatomical considerations. Unlike minimal access approaches, it has fewer technical constraints, ensuring broader eligibility. Mastectomy Rates Around the World and in Singapore Globally, mastectomy rates vary widely due to differences in healthcare practices, cultural attitudes, access to reconstructive surgery and alternative treatments like breast-conserving surgery (BCS) and radiotherapy. For average-risk women in USA, overall mastectomy rates are 31% with a rising trend of double mastectomies of up to 49% in certain states[3][4]. Such a trend was not observed in Europe, as reported by an Italian study where mastectomy rates have remained stable at 34% with no increase in women opting for double mastectomies[5]. In Singapore – mastectomy rates have remained consistently high over the past two decades. A review over a 10-year period in a single institution from 2001 to 2010 reported mastectomy rates remained high throughout the period, varying between 43% and 59%[6]. Separately another review from another local institution reported 70% of patients treated during the same period underwent mastectomy with a low rate (1.25%) of double mastectomies[7]. Who Needs a Mastectomy? Mastectomy is often necessary for women with large tumours or widespread cancer within the breast. However, advances in cancer screening and treatment have reduced the need for mastectomy in many cases. In Singapore, most breast cancers diagnosed today are small (under 2 cm)[8], making breast-conserving surgery (removing the tumour while preserving the breast) a welcoming option for most patients. For larger cancers, modern therapies like pre-surgery treatments (neoadjuvant therapy) can shrink tumours, allowing many women to avoid mastectomy altogether[9][10]. On the other hand, genetic testing has led to greater awareness and a trend of more healthy but at-risk women considering double mastectomies as a preventive strategy to lower their cancer risk[11]. Special considerations for Scar Concealment in Conventional Mastectomies Increasingly, surgeons have focused on concealing scars wherever possible during conventional mastectomies. Dr. Esther Chuwa from Solis Breast Care & Surgery emphasises, “Surgical scars are a necessity with any surgery: most patient are able to accept that. But by placing incisions in well-hidden areas like the skin folds beneath the breast, we can minimise its visibility while ensuring that oncologic safety is maintained. This approach contributes immensely to patients feeling more confident and hopeful during their recovery as visually, they are not constantly reminded of their diagnosis” This approach ensures that oncologic principles, including adequate tumour removal, are not compromised while simultaneously addressing the patient’s aesthetic and emotional concerns.  Considering these factors plays a significant role in enhancing the emotional well-being and overall recovery of breast cancer patients. Looking Ahead While keyhole surgeries offer smaller scars and potentially better wound healing, conventional mastectomy remains a trusted and effective choice for breast cancer surgery. As technology advances, keyhole approaches may gain momentum in replacing the conventional approach as the standard of care, but for now, the conventional approach continues to deliver excellent outcomes for most patients. The future of breast surgery is bright, with ongoing research exploring new tools and techniques to improve care. Whether through minimal access or conventional methods, the goal remains the same: safe, effective, and personalised treatment for every patient. Article contributed and reviewed by Dr Esther Chuwa, Senior Consultant and Breast Surgeon at Solis Breast Care & Surgery References: [1] Lai HW et al. Robotic Versus Conventional or Endoscopic-assisted Nipple-sparing Mastectomy and Immediate Prosthesis Breast Reconstruction in the Management of Breast Cancer: A Prospectively Designed Multicenter Trial Comparing Clinical Outcomes, Medical Cost, and Patient-reported Outcomes (RCENSM-P). Ann Surg. 2024 Jan 1;279(1):138-146. [2] Velanovich V. Laparoscopic vs open surgery: A preliminary comparison of quality-of-life outcomes. Surg Endosc. 2000;14:16–21. [3] Kummerow KL, Du LP, Penson DF, Shyr Y, Hooks MA Nationwide trends in mastectomy for early stage breast cancer. JAMA Surg. 2015;150(1):9-16. [4]  Steiner, C.A., Weiss, A.J., Barrett, M.L., Fingar, K.R. and Davis, P.H. (2016) Trends in Bilateral and Unilateral Mastectomies in Hospital Inpatient and Ambulatory Settings, 2005-2013. HCUP Statistical Brief #201. Agency for Healthcare Research and Quality.  [5] Fancellu A et al. Mastectomy patterns, but not rates, are changing in the treatment of early breast cancer. Experience of a single European institution on 2315 consecutive patients. Breast. 2018 Jun;39:1-7.  [6] Chan PM et al. Mastectomy rates remain high in Singapore and are not associated with poorer survival after adjusting for age. SpringerPlus 2015 Nov 10;4:685.  [7] Sim YR et al. Contralateral prophylactic mastectomy in an Asian population: a single institution review. Breast. 2014;23(1):56–62.  [8] Singapore Cancer Registry Annual Report 2022 [9] Golshan M et al. Impact of neoadjuvant therapy on eligibility for and frequency of breast conservation in stage II-III HER2-positive breast cancer: surgical results of CALGB 40601 (Alliance). Breast Cancer Res Treat 2016;160:297-304 [10] Golshan M et al. Impact of neoadjuvant chemotherapy in stage II-III triple negative breast cancer on eligibility for breast-conserving surgery and breast conservation rates: surgical results from CALGB 40603 (Alliance). Ann Surg 2015;262:434-9 [11] Wong, Stephanie M. MD et al. Growing Use of Contralateral Prophylactic Mastectomy Despite no Improvement in Long-term Survival for Invasive Breast Cancer. Annals of Surgery 265(3):p 581-589, March 2017
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All You Need to Know about Breast Cancer Screening: Breast Mammogram and Ultrasound

Mammograms are the globally recommended standard in breast cancer screening for women aged 40 and above. However, many women avoid talking about, or going for regular breast screening because of several concerns: I’ve heard from family/friends that mammograms are painful and uncomfortable There is no radiation exposure for mammograms, which is dangerous and can cause cancer My previous mammograms have resulted in false positive results, so I do not want to deal with the hassle and anxiety I feel healthy so I do not need any screening – I already do my own breast self-examination regularly In this educational video, Dr Sonia Lee, Consultant Radiologist from Luma Women’s Imaging Centre addresses these concerns, and more. By walking you through the process of what to expect during a mammogram, Dr Lee will address your concerns, alleviate fear and provide reassurance and information on breast screening and assessment. Please be mindful that while some breast conditions may be asymptomatic, most abnormal breast conditions are not cancerous. The team at Solis Breast Care & Surgery Centre and Luma Women’s Imaging Centre believe in the importance of breast health education. By equipping you with the knowledge, we want to encourage women to make breast screening a priority. Share this video with your loved ones too – sharing is caring! The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Video reviewed by Dr Sonia Lee, Consultant Radiologist from Luma Women’s Imaging Centre
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