Background

The incidence of cancer in the reproductive age group, usually defined as 15—40 years, is only 60 per 100 000 but this represents 11 000 cases per annum in the UK. In addition, about 1400 childhood cancers occur in individuals under the age of 15 years. Survival rates from childhood cancer have improved dramatically over the last 30 years, with long-term survival rates reaching 75%; it is now estimated that at least 1 in 1000 young adults are survivors of childhood cancer and this is set to rise further. There is thus a large cohort of cancer survivors who may seek fertility after cancer therapy.

The pattern of disease varies across the age range between birth and 40 years. The most common cancers in the under-15 age group are the acute leukaemias and brain and spinal tumours. Older teenagers and young adults suffer from lymphoma, testicular cancer, brain tumours, malignant melanoma, leukaemia and bone and connective tissue sarcomas. In the over-25s the pattern changes and we see breast and cervical cancer, malignant melanoma and colorectal cancer. In their 30s, women are at higher risk of developing cancer than men, largely owing to their excess risk of breast cancer. In general, the youngest patients face the most serious disease, with the most heroic treatments, and they are the most likely to suffer late effects, including impaired fertility.