Fertility concerns, preservation strategies and quality of life in young women with breast cancer: Baseline results from an ongoing prospective cohort study in selected European Centers

Ruggeri, Monica; Pagan, Eleonora; Bagnardi, Vincenzo; Bianco, Nadia; Gallerani, Elisa; Buser, Katharina; Giordano, M.; Gianni, Luca; Rabaglio, Manuela; Freschi, Andrea; Cretella, Elisabetta; Clerico, Mario; Farolfi, Alberto; Simoncini, E.; Ciccarese, Mariangela; Rauch, Daniel; Ramello, Monica; Glaus, A; Berardi, Rossana; Pellanda, Alessandra Franzetti; Ribi, Karin; Gelber, Shari; Partridge, Ann H.; Goldhirsch, Aron; Pagani, Olivia

doi:10.1016/j.breast.2019.07.001

Cited by 88 publications

(92 citation statements)

References 20 publications

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“…Of note, we only counseled women who were potentially interested in FP. Other studies reported FP rates varying from 9 to 58%, with the lower rates seen in studies in unselected young women [9,12,[22][23][24][25][26]. Based on the Dutch Cancer Registry database, we estimate that approximately 20% of women < 41 years and 35% of women < 35 years diagnosed with breast cancer wished referral for counseling.…”

Section: Discussionmentioning

confidence: 76%

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Preserving fertility in young women undergoing chemotherapy for early breast cancer; the Maastricht experience

Vriens

Welle-Butalid

Boer

et al. 2020

Breast Cancer Res Treat

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Purpose We assessed the uptake of fertility preservation (FP), recovery of ovarian function (OFR) after chemotherapy, live birth after breast cancer, and breast cancer outcomes in women with early-stage breast cancer. Methods Women aged below 41 years and referred to our center for FP counseling between 2008 and 2015 were included. Data on patient and tumor characteristics, ovarian function, cryopreservation (embryo/oocyte) and transfer, live birth, and disease-free survival were collected. Kaplan-Meier analyses were performed for time-to-event analyses including competing risk analyses, and patients with versus without FP were compared using the logrank test. Results Of 118 counseled women with a median age of 31 years (range 19-40), 34 (29%) chose FP. Women who chose FP had less often children, more often a male partner and more often favorable tumor characteristics. The 5-year OFR rate was 92% for the total group of counseled patients. In total, 26 women gave birth. The 5-year live birth rate was 27% for the total group of counseled patients. Only three women applied for transfer of their cryopreserved embryo(s), in two combined with preimplantation genetic diagnosis (PGD) because of BRCA1-mutation carrier ship. The 5-year disease-free survival rate was 91% versus 88%, for patients with versus without FP (P = 0.42). Conclusions Remarkably, most women achieved OFR, probably related to the young age at diagnosis. Most pregnancies occurred spontaneously, two of three women applied for embryo transfer because of the opportunity to apply for PGD.

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Section: Discussionmentioning

confidence: 76%

“…adherence to a prescribed systemic treatment in over a quarter of cases [9][10][11][12]. International guidelines recommend that oncologists address the possibility of future infertility with patients with newly diagnosed cancer in their reproductive years [7,13,14].…”

Section: Introductionmentioning

confidence: 99%

Preserving fertility in young women undergoing chemotherapy for early breast cancer; the Maastricht experience

Vriens

Welle-Butalid

Boer

et al. 2020

Breast Cancer Res Treat

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“…Life-saving treatments such as chemotherapy or radiotherapy have several potential long-term adverse effects including gonadotoxicity (2)(3)(4)(5)(6)(7)(8). The subsequent risk of treatment-related infertility and the loss of ovarian endocrine function represent important causes of distress for patients who are diagnosed during their reproductive years (9)(10)(11). Therefore, scientific societies strongly recommend fertility consultation before initiation of anticancer treatments in all patients of childbearing age (12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Controlled Ovarian Stimulation With or Without Letrozole Co-administration for Fertility Preservation: A Systematic Review and Meta-Analysis

et al. 2020

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Background: The co-administration of letrozole during controlled ovarian stimulation (COS) with gonadotropins is used to limit the potentially harmful effects of a supra-physiological rise in estrogen levels on hormone-sensitive cancers. However, the efficacy and safety of adding letrozole to COS remain debated. Methods: This is a systematic review and meta-analysis of published studies that compared the efficacy and safety of COS with co-administration of letrozole vs. COS without letrozole in all patient populations. A secondary analysis was done including only the studies in breast cancer patients. The primary efficacy endpoint was the number of retrieved mature Metaphase II (MII) oocytes. Secondary efficacy and safety endpoints were total number of oocytes, maturation rate, fertilization rate, number of cryopreserved embryos, peak estradiol levels, progesterone levels, and total gonadotropin dose. Data for each endpoint were reported and analyzed thorough mean ratio (MR) with 95% confidence interval (CI). Results: A total of 11 records were selected including 2,121 patients (990 patients underwent COS with letrozole and 1,131 COS without letrozole). The addition of letrozole to COS did not have any negative effect on the number of mature oocytes collected (MR = 1.00, 95% CI = 0.87-1.16; P = 0.967) and the other efficacy endpoints. COS with letrozole was associated with significantly decreased peak estradiol levels (MR = 0.28, 95% CI = 0.24-0.32; P < 0.001). Similar results were observed in the secondary analysis including only breast cancer patients. Bonardi et al. Letrozole for Controlled Ovarian Stimulation Conclusions: These findings are reassuring on the efficacy and safety of COS with gonadotropins and letrozole and are particularly important for fertility preservation in women with hormone-sensitive cancers.

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“…1 About 50% of women aged 40 years or younger in developed coun tries currently diagnosed with breast cancer have not yet com pleted their families, possibly because of delayed childbearing. 2,3 Although 80% of patients in this age group without distant metas tatic disease at presentation are expected to be longterm survi vors (diseasefree for ≥ 20 yr and likely cured 1 ), largely owing to advances in adjuvant chemotherapy and hormonal therapy, most of these lifesaving treatments adversely affect fertility. Potential loss of fertility has been shown to affect treatment decisions.…”

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confidence: 99%

“…In a survey of European patients with breast cancer who received fertilitypreservation counsel ling, most reported that it instilled a profound feeling of hope and was instrumental in improving their coping, regardless of whether they ultimately chose to pursue fertility preservation. 3 Nevertheless, a recent study aimed at increasing attention to fertility issues at oncology centres showed that about 50% of women who were planning to have children before their breast cancer diagnosis were not referred for fertilitypreservation counselling. 7 Many patients who do not access fertility preserva tion ultimately experience deep regret.…”

mentioning

confidence: 99%

Update on fertility preservation for younger women with breast cancer

Glass¹,

Foong²,

Sandwith³

2020

CMAJ

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Fertility concerns, preservation strategies and quality of life in young women with breast cancer: Baseline results from an ongoing prospective cohort study in selected European Centers

Cited by 88 publications

References 20 publications

Preserving fertility in young women undergoing chemotherapy for early breast cancer; the Maastricht experience

Preserving fertility in young women undergoing chemotherapy for early breast cancer; the Maastricht experience

Efficacy and Safety of Controlled Ovarian Stimulation With or Without Letrozole Co-administration for Fertility Preservation: A Systematic Review and Meta-Analysis

Update on fertility preservation for younger women with breast cancer

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