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Fertility Issues for Young Breast Cancer Patients

March 6, 2014

Fertility Issues for Young Breast Cancer Patients

  1. William J. Gradishar, MD, FASCO, FACP

Many have fertility concerns; few pursue preservation strategies.

  1. William J. Gradishar, MD, FASCO, FACP

Young women with breast cancer who are interested in getting pregnant face potentially delaying conception for many years until treatment is complete or the real possibility that natural- or treatment-induced menopause may develop. To shed light on how these patients make decisions regarding fertility, investigators report initial results of an ongoing, prospective, multicenter, cohort study (Helping Ourselves, Helping Others: The Young Women's Breast Cancer Study).

The researchers evaluated 620 early-stage breast cancer patients (median age, 37) identified from pathology records who completed a baseline survey covering fertility issues as well as socioeconomic, medical, and treatment history.

Results were as follows:

  • 68% of patients discussed fertility issues with their physicians before undergoing treatment.

  • 51% were concerned about fertility, including 24% who were very concerned.

  • Greater likelihood of concern about fertility was associated with younger age, nonwhite race, not having children, and prior chemotherapy.

  • Because of fertility concerns, 1% decided to avoid chemotherapy, 2% chose a specific chemotherapy regimen, 3% decided not to receive endocrine therapy, 11% considered receiving endocrine therapy for <5 years, and 10% took steps to preserve fertility.

Comment

It is not surprising that fertility is very important to a substantial portion of young breast cancer patients. Fertility concerns can lead to compromises in what may be viewed as optimal adjuvant therapy in a fraction of patients. What is most striking is the low utilization of fertility-preservation strategies. Greater integration of onco-fertility specialists into the initial evaluation of young breast cancer patients needs to be a priority.

  • Disclosures for William J. Gradishar, MD, FASCO, FACP at time of publication Consultant / Advisory board Biologics, Inc.; Celgene; Myriad; Novartis Grant / research support Breast Cancer Research Fund Editorial boards Clinical Breast Cancer; Journal of Clinical Oncology; Oncology

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