Consider future fertility in young girls receiving cancer Tx. (Present it as 'A Sign of Hope').

MIAMI BEACH -- Fertility may be the last thing on most physicians' minds when they're facing a young girl who has just been diagnosed with cancer.

But it shouldn't be, said Dr. Marc Laufer, chief of pediatric and adolescent gynecology at Children's Hospital and a reproductive endocrinologist at Brigham and Women's Hospital, both in Boston.

"It's sometimes challenging to address these issues, because the parents of a child with cancer are usually quite overwhelmed, understandably so, and they may think that it's a lot to ask the child to go through another procedure to spare her ovaries after she's just gone through some type of surgical procedure for her cancer," he said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology

But doctors can put a positive spin on the discussion. "I present it as a sign of hope. I tell patients we need to talk about this for 'when you survive your cancer and you want to have a baby," he said at the conference.

The risks to fertility of radiation and chemotherapy can vary depending on the age of the patient; the type, severity, and location of her cancer; and the degree of treatment needed. Young girls receiving treatment tend to have fewer future fertility problems than adult cancer patients because they start their therapy with a greater ovarian reserve, he said.

Chemotherapy has a drug-specific, dose-dependent, age-related effect on fertility, whereas radiation therapy tends to pose much higher risks, especially if it is total-body or pelvic radiation, he noted.

Given these considerations, he said young cancer patients have two fertility-sparing options-either surgical or medical, according to Dr. Laufer.