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Professor Bogda Koczwara

15 July 2008

Sometimes, cancer itself is not the issue

Issues of sexuality and fertility are as important as the cancer, particularly in women diagnosed with breast cancer, says a medical oncologist.

Many doctors do not think of sexuality as an important issue in cancer patients because patients often do not talk about it.

However, Associate Professor Bogda Koczwara said sexuality problems are only preceded by fatigue and low energy levels as the most troublesome symptoms of cancer. Koczwara heads the department of medical oncology at Flinders Medical Centre in Australia.

The treatment of cancer can also impact a patient’s sexuality, Koczwara said. “Nausea, fatigue
and weight gain will complicate the problem of body image and impact sexuality.”

Koczwara said while the incidence of breast cancer is highest among menopausal women, premenopausal women make up about 23 percent of new breast cancer diagnoses. Of this figure, 2.3 percent are below 35 years of age.

The latter group is “usually diagnosed with cancers that are more aggressive and treatment is likely to be more complex, leading to the patient experiencing more distress”.

Fertility is also a major concern of this younger group, Koczwara said. “In Western societies, the age of first pregnancy is increasing and, for the past five years, the age of first pregnancy has gone up to 29 years of age.”

“This means that women, at an age when they might be considering motherhood, suddenly have to contend with breast cancer as well.”

There is often increased distress if cancer treatment results in infertility and patients may choose less efficacious therapies to preserve their fertility, Koczwara said, adding that “most survivors prefer to have biological offspring”.


Associate Professor Bogda Koczwara is a medical oncologist, an ethicist and the Head of Department of Medical Oncology at Flinders Medical Centre and Flinders University in Adelaide. Dr Koczwara completed her oncology training at the Roswell Park Cancer Institute in Buffalo, New York, where she refined her interests in research ethics and patient decision-making. Her clinical interests revolve around management of breast and gynecological malignancies, psycho-oncology and supportive care
and she is an active member of collaborative research groups in these areas. Dr. Koczwara is the Chairperson of the Medical Oncology Group of Australia, the Chair of the Cancer Council Oncology Education Committee and the Chair of the Australia Asia Pacific Clinical Oncology Research Development (ACORD) - an initiative of the Medical Oncology Group of Australia to share the wealth of knowledge and research skills of its members and use them to benefit the region.

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