Fertility Concerns Affect Treatment Decisions in Younger Women with Breast Cancer
Fertility concerns affect treatment decisions in a substantial proportion of young women with breast cancer; however, few women pursue available fertility preservation strategies, according to the results of a study published in the Journal of Clinical Oncology.
Women who confront a cancer diagnosis at a young age often must consider how cancer treatment will affect their ability to have children in the future. In the case of breast cancer, the likelihood of infertility is determined by multiple factors that include the patient’s age at the time of treatment and the specific type and length of treatment. In some cases, treatment with chemotherapy may result in permanent or temporary infertility. When treatment for breast cancer may result in infertility, it is important to inform patients about this possibility and their options for preserving their fertility.
As part of an ongoing prospective multicenter cohort study (Helping Ourselves, Helping Others: The Young Women’s Breast Cancer Study), researchers surveyed women aged 40 or younger with newly diagnosed early-stage breast cancer. The baseline survey included sociodemographic, medical, and treatment data as well as a modified Fertility Issues Survey, including fertility concern and preservation items.
The median age among the first 620 eligible respondents included in this analysis was 37. Approximately one-third of the women expressed a desire to have children in the future. Sixty-eight percent of women reported discussing fertility issues with their physicians prior to starting treatment and 51 percent were concerned about becoming infertile after treatment.
A total of 26 percent of women reported that fertility concerns affected their treatment decisions. As a result of fertility concerns, 1 percent chose not to receive chemotherapy, 2 percent chose one chemotherapy regimen over another, 1 percent considered not receiving endocrine therapy, 3 percent decided not to receive endocrine therapy, 11 percent considered receiving endocrine therapy for less than 5 years, and 1 percent chose to have mastectomy.
Ten percent of women used fertility preservation strategies, including embryocryopreservation, oocyte cryopreservation, and gonadotropin-releasing hormone use.
Greater concern about fertility was associated with younger age, nonwhite race, not having children, and receipt of chemotherapy.
The researchers concluded that many young women with newly diagnosed breast cancer have fertility concerns. These fertility concerns sometimes affect treatment decisions, but only a small percentage of women pursue available fertility preservation strategies.
Ruddy KJ, Gelber SI, Tamimi RM, et al: Prospective study of fertility concerns and preservation strategies in young women with breast cancer. Journal of Clinical Oncology. Published early online February 24, 2014. doi: 10.1200/JCO.2013.52.8877
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