Update on fertility preservation for younger women with breast cancer

Glass, Karen; Foong, Shu; Sandwith, Emily

doi:10.1503/cmaj.200245

Cited by 12 publications

(8 citation statements)

References 42 publications

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“…Although endocrine therapy has no reproductive toxicity, endocrine treatment lasts for 5–10 years, and the ovarian function of patients continues to decrease with age. Therefore, breast cancer patients with fertility needs are recommended fertility preservation before endocrine therapy [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…It may be related to the postponement of the age of first pregnancy and the continued increase in the incidence of young breast cancer [ 6 ]. With the development of early diagnosis and treatment strategies for breast cancer, the disease-free and overall survival rate of patients with breast cancer have been greatly improved [ 7 ]. However, compared with unaffected women, the fertility rate of breast cancer patients decreases significantly about 40–67% after diagnosis and treatment.…”

Section: Introductionmentioning

confidence: 99%

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Ovarian tissue cryopreservation in a patient with breast cancer during pregnancy: a case report

Cheng

Ruan

et al. 2021

J Ovarian Res

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Background Fertility preservation using ovarian tissue cryopreservation (OTC) in patients with certain diseases, especially those needing chemo- or radiotherapy, is becoming routine in various Western countries. Our hospital is the first and until now the only centre in China to use this method. The question of whether treatment of breast cancer during pregnancy (PrBC) should be similar to non-pregnant young patients with breast cancer is controversial. To our knowledge, this is the first report worldwide to use OTC as fertility preservation for PrBC. Case presentation During the 29th week of pregnancy, a 24-year-old woman underwent needle aspiration cytology of a left breast tumour. Ultrasound and cytology revealed BI-RADS 4a grade. Oncologists recommended termination of the pregnancy. Caesarean section was performed at week 32, and ovarian tissue samples were collected for OTC to preserve fertility and ovarian endocrine function. Twenty-three ovarian cortex slices were cryopreserved. It is estimated that 13,000 follicles were cryopreserved. Breast nodules and sentinel lymph node biopsy suggested invasive micropapillary carcinoma. Neoadjuvant chemotherapy was started within 1 week after diagnosis. After six courses of neoadjuvant chemotherapy, targeted drug therapy and goserelin acetate, left mastectomy and left axillary lymph node dissection were performed. In total, 23 doses of radiotherapy, eight trastuzumab targeted therapy treatments, and 17 pertuzumab + trastuzumab double targeted therapy treatments were performed after breast cancer surgery. Until now, more than 2 years after delivery, the ovarian function still is good, and no signs of a negative impact of OTC have been observed. Goserelin acetate injections, administered every 28 days, are planned to last for the next 5 years. In addition, endocrine therapy with anastrozole was started after breast cancer surgery and also is scheduled for 5 years. Conclusion OTC for fertility preservation in patients with PrBC does not delay breast surgery, radiotherapy or chemotherapy, which is essential for effective treatment of breast cancer. We assess this method as a promising fertility preservation method which was used here for the first time worldwide in a patient who developed breast cancer during pregnancy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ovarian tissue cryopreservation in a patient with breast cancer during pregnancy: a case report

Cheng

Ruan

et al. 2021

J Ovarian Res

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“…In contrast to gamete cryopreservation, the embryo cryopreservation program is adjustable for having another attempt, after a negative IVF outcome, where spare embryos that have been cryopreserved can be used in a subsequent frozen embryo transfer cycle without repetition of ovarian stimulation and oocyte retrieval. Alternatively to oocyte freezing, embryo freezing can also offer FP in women diagnosed with breast cancer, as it is known that women with breast cancer are subjected to gonadotoxic treatments that may affect their fertility ( 7 , 8 ). The performance of gametes or embryo freezing, and storage takes place in order to exchange them from donors to recipients after participation in donor programs following eligibility-approved criteria ( 9 – 11 ).…”

Section: Routinely Applied Assisted Reproductive Technologies For Fer...mentioning

confidence: 99%

A comprehensive review and update on human fertility cryopreservation methods and tools

et al. 2023

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The broad conceptualization of fertility preservation and restoration has become already a major concern in the modern western world since a large number of individuals often face it in the everyday life. Driven by different health conditions and/or social reasons, a variety of patients currently rely on routinely and non-routinely applied assisted reproductive technologies, and mostly on the possibility to cryopreserve gametes and/or gonadal tissues for expanding their reproductive lifespan. This review embraces the data present in human-focused literature regarding the up-to-date methodologies and tools contemporarily applied in IVF laboratories' clinical setting of the oocyte, sperm, and embryo cryopreservation and explores the latest news and issues related to the optimization of methods used in ovarian and testicular tissue cryopreservation.

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“…Many physicians and organizations suggest that women postpone pregnancy for 6 to 12 months after finishing chemotherapy to prevent conception with an oocyte that was maturing during chemotherapy [179]. In young women with estrogen receptor-positive (ER+) breast cancer, because adjuvant anti-estrogen therapy is required for 5-10 years, it can lead to a delay of childbearing [180]. However, there is insufficient information about when it is safe to become pregnant after treatment for cancer.…”

Section: Timing Of Conception After Cancer Treatmentmentioning

confidence: 99%

Advances in the Treatment and Prevention of Chemotherapy-Induced Ovarian Toxicity

Cho

Lee

Min

et al. 2020

IJMS

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Due to improvements in chemotherapeutic agents, cancer treatment efficacy and cancer patient survival rates have greatly improved, but unfortunately gonadal damage remains a major complication. Gonadotoxic chemotherapy, including alkylating agents during reproductive age, can lead to iatrogenic premature ovarian insufficiency (POI), and loss of fertility. In recent years, the demand for fertility preservation has increased dramatically among female cancer patients. Currently, embryo and oocyte cryopreservation are the only established options for fertility preservation in women. However, there is growing evidence for other experimental techniques including ovarian tissue cryopreservation, oocyte in vitro maturation, artificial ovaries, stem cell technologies, and ovarian suppression. To prevent fertility loss in women with cancer, individualized fertility preservation options including established and experimental techniques that take into consideration the patient’s age, marital status, chemotherapy regimen, and the possibility of treatment delay should be provided. In addition, effective multidisciplinary oncofertility strategies that involve a highly skilled and experienced oncofertility team consisting of medical oncologists, gynecologists, reproductive biologists, surgical oncologists, patient care coordinators, and research scientists are necessary to provide cancer patients with high-quality care.

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Update on fertility preservation for younger women with breast cancer

Abstract: How does breast cancer treatment affect ovarian function? Women are born with a finite number of oocytes, also known as ovarian reserve. This pool of oocytes declines over time until menopause or ovarian failure. As ovarian reserve declines, so does fertility. 9

Cited by 12 publications

References 42 publications

Ovarian tissue cryopreservation in a patient with breast cancer during pregnancy: a case report

Ovarian tissue cryopreservation in a patient with breast cancer during pregnancy: a case report

A comprehensive review and update on human fertility cryopreservation methods and tools

Advances in the Treatment and Prevention of Chemotherapy-Induced Ovarian Toxicity

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