Fertility and Breast Cancer
- TODAY host Hoda Kotb has been open about her journey to motherhood after experiencing fertility struggles following her breast cancer battle. Today, she’s the proud mother of two adopted little girls.
- Kotb, 57, was diagnosed with breast cancer in February 2007 at age 43 after doctors discovered lumps in her breast tissue during a routine exam. She then underwent a mastectomy and reconstruction followed by five years of taking the drug tamoxifen (Nolvadex).
- Fertility preservation practices for women can include egg and embryo freezing, ovarian tissue freezing, ovarian suppression and ovarian transposition.
- According to our experts, people with breast cancer face unique challenges when it comes to fertility. If they need chemotherapy, their eggs could be damaged. Also, if a women’s treatment calls for medication to stop specific hormones, they might not be able to get pregnant for several years or, in some instances, 10.
- Breast cancer is a common cancer that has been the subject of much research, so there are many treatment options out there. Mammograms, a standard screening procedure for breast cancer, and self breast exams can save lives.
The co-anchor of TODAY with Hoda & Jenna is mother to her little girls Haley Joy, 5, and Hope Catherine, 3. She adopted Haley in 2017 and Hope two years later with her now ex-fiancé, financier Joel Schiffma, 64.Read More
“I said, ‘I do.’ I didn’t say did. I said I do,” Kotb shared on the first episode of the podcast Me Becoming Mom by PEOPLE. “It was an everyday moment that turned into an epiphany.”
After talking to her then-boyfriend, Schiffman, the couple immediately contacted an adoption agency. A month after submitting the adoption application, Kotb got a life-changing text from her adoption worker: “She’s here.”
“I don’t know what giving birth feels like, but I sure know what my heart felt like when I heard those words,” Kotb said. “It was magical.”
And the connection with her daughters was instant. To this day, Kotb still gets chills thinking of the first time she met Haley.
“They put her in my arms. I haven’t carried many babies. She fit like she was born there,” Kotb said. “I thought to myself, ‘Forever, as long as I have a breath in me, you will be loved and cared for.’
“She felt like mine right then. It didn’t take any time. It happened instantly for me.”
Hoda Kotb’s Breast Cancer Journey
Although everything has worked out for Kotb as far as becoming a mother, she had to deal with the heartbreak of a cancer diagnosis and fertility struggles before she could get to where she is today.
Kotb received her breast cancer diagnosis in February 2007 after doctors discovered lumps in her breast tissue during a routine exam. She was 43 at the time and underwent a mastectomy and reconstruction followed by five years of taking the drug tamoxifen (Nolvadex).
“Cancer shaped me, but it did not define me. It’s part of me, but not all of me,” Kotb said at an annual Breast Cancer Research Foundation New York Symposium and Awards Luncheon in 2017.
She’s still cancer-free today, but Kotb has since opened up about her fertility struggles following her breast cancer battle.
“I remember that my oncologist called, and we were talking about freezing my eggs,” Kotb told Good Housekeeping. “She basically said that given my age and (my breast cancer treatment), it was pretty close to a dead-end.”
Her reaction was, understandably, filled with sorrow. And at that moment, she doubted she’d ever realize her dream of becoming a mother.
“I was in my room, and I just sobbed. I thought, ‘Well, that’s that, isn’t it?,’” Kotb said. “Like, you almost blame yourself. ‘Why didn’t I do this? Why didn’t I do that?’ So I just pushed it away because the reality seemed impossible to bear.
“How do you survive knowing you can’t have what you desire and what you feel like you actually physically need?”
But fast forward to today, and Kotb loves taking care of her two girls, Haley and Hope. And she thanks her ex-fiancé, Schiffman, for providing the support she needed to become a mother.
“I don’t think I would’ve adopted if it hadn’t been for Joel,” she said of Schiffman. “Having a stable relationship in that moment was really important. Once that fell into place, it didn’t seem as scary to me.”
Fertility and Cancer Treatment
Infertility can be a side effect of some cancer treatments, but there are options to consider. Fertility preservation, for example, is available to women of childbearing age. Options for women include:
- Egg and embryo freezing (the most common practice)
- Ovarian tissue freezing
- Ovarian suppression to prevent the eggs from maturing so that they cannot be damaged during treatment.
- Ovarian transposition, for women getting radiation to the pelvis, to move the ovaries out of the line of treatment.
No matter what course of action you choose to take, it is important that all women feel comfortable discussing their options prior to cancer treatment.
In a previous conversation with SurvivorNet, Dr. Jaime Knopman, a reproductive endocrinologist at CCRM NY, says time is precious when dealing with fertility preservation for women with cancer. In other words, the sooner the better when it comes to having these important fertility conversations with your doctor.
“The sooner we start, the sooner that patient can then go on and do their treatment,” Dr. Knopman said. “A lot of the success comes down to how old you are at the time you froze and the quality of the lab in which your eggs or embryos are frozen in.”
When it comes to breast cancer patients specifically, there are some unique challenges for women with the disease. Dr. Elizabeth Comen, a medical oncologist at Memorial Sloan Kettering Cancer Center, outlines them in a previous interview with SurvivorNet:
- Young women who need chemotherapy could have their fertility significantly affected because many chemotherapy drugs can damage a woman’s eggs.
- If women are on a medication to stop the hormones which feed their specific kind of breast cancer, they may not be able to get pregnant for several years – in some instances 10 years.
- Many stage four breast cancers need estrogen to grow. Pregnancy is a very, very high hormonal state, so it’s not recommended in these cases.
Understanding Breast Cancer
Breast cancer is a common cancer that has been the subject of much research. Many women develop breast cancer every year, but men can develop this cancer too – though it is more rare, in part, due to the simple fact that they have less breast tissue.
Screening for breast cancer is typically done via mammogram, which looks for lumps in the breast tissue and signs of cancer. The American Cancer Society (ACS) says women should begin yearly mammogram screening for breast cancer at age 45 if they are at average risk for breast cancer. The ACS also says those aged 40-44 have the option to start screening with a mammogram every year, and women age 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms.
It’s also important to be on top of self breast exams. If you ever feel a lump in your breast, you should be vigilant and speak with your doctor right away. Voicing your concerns as soon as you have them can lead to earlier cancer detection which, in turn, can lead to better outcomes.
There are many treatment options for people with this disease, but treatment depends greatly on the specifics of each case. Identifying these specifics means looking into whether the cancerous cells have certain receptors. These receptors – the estrogen receptor, the progesterone receptor and the HER2 receptor – can help identify the unique features of the cancer and help personalize treatment.
“These receptors, I like to imagine them like little hands on the outside of the cell, they can grab hold of what we call ligands, and these ligands are essentially the hormones that may be circulating in the bloodstream that can then be pulled into this cancer cell and used as a fertilizer, as growth support for the cells,” Dr. Comen previously told SurvivorNet.
One example of a type of ligand that can stimulate a cancer cell is the hormone estrogen, hence why an estrogen receptor positive breast cancer will grow when stimulated by estrogen. For these cases, your doctor may offer treatment that specifically targets the estrogen receptor. But for HER2 positive breast cancers, therapies that uniquely target the HER2 receptor may be the most beneficial.