Prospective Study of Fertility Concerns and Preservation Strategies in Young Women With Breast Cancer

Abstract

A B S T R A C T PurposeMost research regarding fertility in young women with breast cancer has focused on long-term survivors. Little is known about how fertility concerns affect treatment decisions or fertility preservation strategies at the time of initial cancer diagnosis. Patients and MethodsAs part of an ongoing prospective multicenter cohort study, we surveyed women with newly diagnosed early-stage breast cancer at age Յ 40 years. The baseline survey included sociodemographic, medical, and treatment data as well as a modified Fertility Issues Survey, including fertility concern and preservation items. Univariable and multivariable modeling were used to investigate predictors of greater fertility concern.Results Among the first 620 eligible respondents included in this analysis, median age was 37 years (range, 17 to 40 years); 425 women (68%) discussed fertility issues with their physicians before starting therapy, and 319 (51%) were concerned about becoming infertile after treatment. Because of concerns about fertility, four women (1%) chose not to receive chemotherapy, 12 (2%) chose one chemotherapy regimen over another, six (1%) considered not receiving endocrine therapy, 19 (3%) decided not to receive endocrine therapy, and 71 (11%) considered receiving endocrine therapy for Ͻ 5 years; 65 (10%) used fertility preservation strategies. Greater concern about fertility was associated with younger age, nonwhite race, not having children, and receipt of chemotherapy. ConclusionMany young women with newly diagnosed breast cancer have concerns about fertility, and for some, these substantially affect their treatment decisions. Only a minority of women currently pursue available fertility preservation strategies in this setting.

Ovarian Function after Chemotherapy in Young Breast Cancer Survivors

“…Partridge et al 4 reported that fertility after treatment was a significant concern for approximately 60% of young women with early breast cancer and that fertility concerns would influence the treatment decisions of 26% of women 6 . As cure rates continue to improve, clinical advances to develop less gonadotoxic therapy and to intervene more effectively so that survivors can achieve their reproductive goals will be required.…”

“…Consequently, the longterm toxicities of breast cancer treatment are of increasing relevance, and several studies have found that fertilityrelated concerns greatly affect quality of life for young breast cancer survivors [3][4][5][6] . Such issues are likely to become more important given that the number of women delaying childbirth is increasing 7 .…”

Risk of chemotherapy-induced amenorrhea in patients with breast cancer: a systematic review and meta-analysis

“…Many young patients with breast cancer have concerns on fertility when discussing with their oncologist about adjuvant therapy; these concerns may influence their treatment decisions [5][6][7]. Taking into account the effect of fertility issues on patients' quality of life, the American Society of Clinical Oncology recommends that oncologists discuss the risk of infertility and fertility preservation options in patients with cancer as early as possible before treatment starts [18].…”

“…dose dense chemotherapy). The estimate of effect is based only on one study (Ruddy et al 2014; online reference list).…”

“…Chemotherapy-induced amenorrhea (CIA) is a well known toxicity after chemotherapy in young breast cancer patients that has traditionally served as a surrogate marker of infertility. The majority of young breast cancer patients have concerns about treatment-induced infertility [5,6] and in some cases these concerns influence their treatment decision [5][6][7][8]. However, the discussion about CIA and infertility risk between oncologists and their patients remains limited [5,6] and a potential barrier is the lack of knowledge and consistent evidence on these issues [9,10].…”