At death’s door, young cancer patients, regardless of gender, face the hurdles of saving their own lives and preserving the hope of creating new ones. With advanced technology, it’s now possible to achieve both. Li Bingcun reports from Hong Kong.
It all started when Chan, 32, felt a tiny, solid lump in one of her breasts in September. The discovery came as a shock and threatened her life, as well as her ability to conceive.
She had feared the worst — breast cancer — but did not suspect it was the dreaded disease as she had been maintaining a healthy lifestyle, plus the fact that no member of her family has ever had the disease. Her world came tumbling down when her fears were confirmed after she went for a diagnosis.
Supporting more young patients to preserve fertility in advance not only offers them the physical ability to choose parenthood, it invigorates their confidence to lead lives as vibrant and fulfilling as anyone else’s.
Iris Chan, Head of service of the Hong Kong Cancer Fund
It was a hard and painful truth for Chan to accept. She was in the prime of her career, and she was planning to have a baby next year after three years of marriage. Although she knew how common breast cancer is among women and the relatively high cure rate for patients during the early stage, the fact that the disease is the third-leading cause of cancer deaths among Hong Kong women made her panic.
The inexplicable origins of the cancer fueled immense fear in Chan, causing her restless nights and incessant worries about the treatment she had to undergo, as well as the risk of a relapse. She then discovered another brutal possibility — she might not be able to give birth even after she’s cured.
Cancer patients normally undergo chemotherapy and radiotherapy to kill the cancer cells — a process that can cause irreversible damage to their reproductive functions.
Chan hasn’t given much thought to how many children she wants, but having children seems to be a natural choice for her. After consulting doctors, she chose to preserve her fertility in advance, and made her decision within a week following her diagnosis.
After undergoing surgery in October to remove the tumor, Chan went through an ovarian stimulation process and had 13 eggs retrieved the following month. With assisted reproduction technology (ART), she froze two embryos for pregnancy in the future.
She breathed a sigh of relief, then put her entire focus on treatment and eventual recovery that would allow her to give birth.
Cancer — a silent killer — is afflicting younger people at an increasing pace, resulting in the need for both male and female patients to seek ways to preserve their fertility. The number of cancer patients per 100,000 Hong Kong people in 2021 surged by 23 percent in the 22-44 age group, compared with in 2000. In 2021, the city recorded 3,100 new cancer cases among people aged below 45.
Worldwide, fresh cases of cancer among people under 50 had skyrocketed by a stunning 79 percent in the three decades from 1990 to 2019, according to a study published in the United Kingdom-based medical journal BMJ Oncology.
Common forms of cancer that strike young people are mostly related to their reproductive systems. They attack women’s breasts, ovarian and cervical systems, and men’s testicles. Other notable types include thyroid cancer, nasopharyngeal cancer and colorectal cancer.
Human reproductive organs are extremely sensitive to injury from diseases, medication, chemotherapy and radiation. To avoid damaging a person’s fertility through anti-cancer treatment, doctors recommend that young patients with a relatively high cure rate freeze their eggs, sperm, embryos, or ovary and testis tissues in advance to preserve fertility.
After recovery, a patient can thaw the reproductive cells or tissues and have children. For some hereditary diseases, pre-implantation genetic testing technology can help screen out pathogenic genes of embryos before implanting them into women’s wombs.
With the advancements made in medical technology, the overall survival rate of cancer patients has improved remarkably, enabling them to consider matters they would not dare think of before, especially fertility, says Jacqueline Chung Pui-wah, director of the Assisted Reproductive Unit at the Chinese University of Hong Kong. “Many patients have a long life ahead of them after they’re cured. Apart from curing the disease, we’re obliged to plan more for their future.”
Besides the high costs of anti-cancer treatment, young people opting to preserve their fertility also need to fork out additional fees that could exceed HK$100,000 ($12,820).
To alleviate their financial worries, the Hong Kong Cancer Fund launched a subsidy program in August to support cancer patients aged 18 to 35 years in preserving their fertility. With an annual quota of 100 cases, the fund offers a maximum of HK$30,000 to each patient. Chan is among the beneficiaries.
Power of love
With more young people diagnosed with cancer, the trend in delaying marriages and childbearing has intensified the negative impact, subjecting a greater proportion of the population to the life-threatening ordeal before embarking on parenthood.
Zhang was diagnosed with near-advanced nasopharyngeal cancer in 2018 when he was 37. Other people of his age might already have had more than one child. But he had not yet tied the knot with anyone.
Born and living in Guangdong province, Zhang has been in a stable relationship with his girlfriend Xie Haoyi. Their relationship faced its biggest test when he went for a diagnosis. Concerned about their future quality of life, Xie’s family wanted them to end the relationship. Zhang also felt like giving up on it himself, having refused to get treatment at one stage.
Given her deep love for Zhang, Xie decided to stick with her boyfriend through thick and thin and to ride it out despite strong objections from her parents. With Xie’s prodding and encouragement, Zhang stored five vials of sperm at the Guangdong Human Spermbank before he underwent cancer treatment.
Zhang received four chemotherapy and 33 radiation treatments within two months. He developed severe mouth ulcers as a side effect, and had to numb his mouth with anesthesia before eating. To take care of him, Xie spent two hours driving back and forth between their home and the hospital every day.
Zhang made a spectacular recovery, and they were married half a year later. Through ART, they have a two-year-old son, cute and healthy, and is very attached to his mother.
Other cancer patients may not be as lucky as Zhang. Some have chosen to confront the challenge themselves in solitude in order to spare their families the burden of having to care for them. Due to worries about fertility implications, some have even been abandoned by their partners.
Among young cancer patients, hereditary cancer is more prevalent, making it harder for them to accept it as the disease is not directly linked to their lifestyle or connected to a more sedentary lifestyle due to aging. Many approach their plight with a positive mindset, actively seeking information and exploring potential solutions. Nevertheless, what they have had to go through is still hard to bear, says Iris Chan, head of service of the Hong Kong Cancer Fund.
“In the prime of their lives, these young people aspired to success in their careers and the joy of starting a family, and some were still pursuing their studies. However, being diagnosed with cancer abruptly shattered their lives, driving them into uncertainty and upheaval,” she says.
Although some cancer patients may have managed to escape the clutches of death, they still have to grapple with other challenges. Besides the lingering fear of a relapse, they have to face profound changes in life, such as no longer being able to pursue their previous careers and interests.
For some, the possibility of preserving their fertility only dawns on them after they’ve completed their cancer treatment, leaving them with the difficult choice of whether to use the sperm or eggs of willing donors. “It becomes all too easy for them to lose hope and motivation for the future,” says Iris Chan.
“Supporting more young patients to preserve fertility in advance not only offers them the physical ability to choose parenthood, it invigorates their confidence to lead lives as vibrant and fulfilling as anyone else’s,” she believes.
Tech challenges
Currently, the technology for fertility preservation has reached a relatively advanced stage. However, with significant breakthroughs, it still faces certain limitations and bottlenecks.
In recent years, Chung and her team at the CUHK have introduced a technology for ovarian tissue cryopreservation (preservation through the freezing of cells and other biological material) and transplantation — a significant step in preserving women’s reproductive ability in Hong Kong.
Before cancer treatment, small pieces of ovarian tissue from the patient are removed and frozen for preservation. After treatment, they can be transplanted back into the patient’s body to resume functioning.
This method saves time in ovarian stimulation, which often needs two to three weeks. It’s especially suitable for adolescent girls requiring immediate cancer treatment, as well as young female patients whose conditions do not permit them to receive hormone stimulation.
The technology has led to 200 live births worldwide. Yet due to its complexity, widespread implementation still requires more time.
For sperm freezing, there are still some hurdles to overcome, according to Zhang Xinzong, director of the Guangdong Human Spermbank. As China’s largest autologous sperm banking center for cancer patients, the institution has helped more than 2,000 cancer patients preserve their fertility since its inception in 2003.
If a child develops cancer before reaching puberty, the reproductive system has yet to fully mature, making it challenging to freeze the sperm. Although current technology allows for the cryopreservation of testicular tissues, the process of regenerating sperm from these tissues is still under research.
According to Zhang Xinzong, the utilization rates for both sperm and eggs are also relatively low. Some patients still die despite treatment. Some adolescents are too young to use frozen cells, and a small portion of patients have regained fertility and achieved natural conception. He also cautioned that although the patients have frozen the reproductive cells in advance, given the limited success rate of ART, it does not guarantee a baby for them.
Overall, compared to the vast number of cancer patients with fertility preservation needs, the proportion of those seeking the service remains low. There’s still significant room for improvement, especially greater efforts by doctors and patients themselves, Zhang Xinzong believes.
Iris Chan says the Hong Kong Cancer Fund would like the Hospital Authority to ensure that more public doctors know how to help young cancer patients preserve their fertility, such as transferring them to designated hospitals for fertility counseling, and promoting related subsidy and public support projects. Doctors in private practice should also have more awareness in this field.
Zhang Xinzong hopes that more guidelines will be drawn up for medical workers in this regard, adding there should be closer interdisciplinary collaboration in the fields of oncology, obstetrics and gynecology, urology, reproductive medicine and surgery to offer better treatment to patients.
Humphrey Choi, a Hong Kong specialist in obstetrics and gynecology, feels that deeper direct communication and wider sharing of medical records among doctors from various departments is important.
He warns that patients shouldn’t forsake appropriate cancer treatment options due to concerns about their fertility. “Cancer can progress rapidly. They should never delay treatment until after pregnancy or childbirth.”
Along the lengthy post-recovery journey, there’s still a string of challenges for patients like Chan and Zhang. Some are foreseeable, like striving to keep themselves in the pink of health, and the conceiving and raising of children. Other hurdles might come at them out of the blue. “At least, we’ve made our utmost efforts, whether it’s saving ourselves or becoming parents. So there will be no regrets,” said Chan.
Contact the writer at bingcun@chinadailyhk.com
