Documented Fertility Counseling May Be Low Among Young Patients With Breast Cancer

Today, a range of new and increasingly effective avenues are available to help women start a family following breast cancer treatment. But they typically involve decisions made in advance of therapy, with limited options once treatment is underway.


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Researchers at the Cleveland Clinic conducted a retrospective study that reviewed all women age 40 and younger treated for breast cancer with chemotherapy and/or anti-hormonal therapy at their institution from 2006 to 2014.3 The study involved 303 qualifying patients with an average age of 35.7 years and a median follow-up of 3.7 years. At diagnosis, 32% were single, 68% married, and 27% had no children. Eighty patients (26%) had a documented FD. Of these, only 9 (11%) did not pursue in vitro fertilization (IVF) consultation or gonadotropin-releasing hormone (GnRH) agonists for ovarian protection during chemotherapy.

The researchers found that documented FD and referral in women age 40 and younger who have been diagnosed with breast cancer remains low. Although not every woman in the cohort desired pregnancy, 71 out of 80 (89%) of those having a documented FD sought some form of fertility preservation.

Primary study author Devina McCray, MD, a breast surgical oncology fellow at the Cleveland Clinic in Cleveland, OH, said the study demonstrated that regardless of whether a woman eventually attempted to become pregnant, most wanted to maintain the option. She said women concerned with future childbearing should actively seek out assisted reproduction counseling before starting breast cancer treatment.

Of the 303 women studied, 22 (7%) became pregnant within the median 3.7-year follow-up period. Fifty-five (69%) patients received counseling about IVF procedures, and 17 (31%) pursued this option. Of these, 4 (24%) eventually became pregnant, as did 5 patients treated with GnRH. Ten patients not pursuing IVF consultation or GnRH became pregnant spontaneously. Overall successful pregnancy was associated with younger age at the time of diagnosis and estrogen receptor–negative and progesterone receptor–negative tumors.

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Dr McCray encouraged physicians to discuss fertility with their patients, including assessing the desire for future fertility, reviewing the risks of treatment on future fertility, and exploring fertility preservation options.

“As caretakers, it should be our responsibility not only to treat the breast cancer but also to support women during their survivorship so they can regain the life and goals they had prior to breast cancer,” Dr McCray told Cancer Therapy Advisor.

References

  1. Khan S, Epstein M, Lagios M, Silverstein M. Are we overtreating ductal carcinoma in situ (DCIS)? Presented at: 17th Annual Meeting of the American Society of Breast Surgeons; April 13-17, 2016: Dallas, TX. Abstract 0242.
  2. Plichta J, Coopey S, Specht M, et al. Application of the 2015 ACS and ASBS screening mammography guidelines: risk assessment is critical for women ages 40-44. Presented at: 17th Annual Meeting of the American Society of Breast Surgeons; April 13-17, 2016: Dallas, TX. Abstract 0445.
  3. McCray D, Simpson A, Liu Y, et al. Fertility in young women of child-bearing age after breast cancer: are we giving them a better chance? Presented at: 17th Annual Meeting of the American Society of Breast Surgeons; April 13-17, 2016: Dallas, TX. Abstract 0322.