scholarly journals Counseling young women with early breast cancer on fertility preservation

2019 ◽  
Vol 36 (12) ◽  
pp. 2593-2604 ◽  
Author(s):  
M. E. (Elena) ter Welle-Butalid ◽  
I. J. H. (Ingeborg) Vriens ◽  
J. G. (Josien) Derhaag ◽  
E. M. (Edward) Leter ◽  
C. E. (Christine) de Die-Smulders ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Fertility Preservation ◽  
Young Women ◽  
Cancer Survival ◽  
Ovarian Function ◽  
Early Stage ◽  
Genetic Diagnosis ◽  
Oncological Treatment ◽  
Future Child ◽  
Child Wish

Abstract Purpose Women with early-stage breast cancer may still have a future child wish, while chemotherapy may impair fertility. To pursue on fertility preservation shortly after breast cancer diagnosis is complex. This review holds a critical reflection on all topics that need to be counseled to give them the opportunity to make a well-informed decision before starting any oncological treatment. Methods A comprehensive literature review was performed on papers published in English language on breast cancer in young women, risk of chemotherapy-induced infertility, fertility preservation techniques, impact of possible mutation carriership, and future pregnancy outcome. Results Below 40 years of age, the risk of permanent chemotherapy-induced ovarian function failure is approximately 20%, where taxanes do not significantly add to this risk. Overall, 23% of reported women who performed fertility preservation by cryopreserving oocytes or embryos returned for embryo transfer. Of these, 40% gave live birth. Both fertility preservation in women diagnosed with breast cancer and pregnancy after treatment seem safe with respect to breast cancer survival. Women who have a genetic predisposition for breast cancer like BRCA gene mutation should also be informed about the possibility of pre-implantation genetic diagnosis. Conclusions Women with an early stage of breast cancer and a possible future child wish should be referred to an expertise center in breast cancer, fertility preservation, and genetics in this complex decision-making process, shortly after diagnosis.

scholarly journals Amenorrhea, fertility preservation, and counseling among young women treated with anthracyclines and taxanes for early-stage breast cancer, a retrospective study

Medicine ◽  
2020 ◽  
Vol 99 (11) ◽  
pp. e19566 ◽  
Author(s):  
Hikmat N. Abdel-Razeq ◽  
Razan A. Mansour ◽  
Khawla S. Ammar ◽  
Rashid H. Abdel-Razeq ◽  
Hadil Y. Zureigat ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Retrospective Study ◽  
Fertility Preservation ◽  
Young Women ◽  
Early Stage ◽  
Early Stage Breast Cancer

P–457 Emergency fertility preservation (FP) in female patients- utilisation rate of the stored eggs/embryos and pregnancy outcomes

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
V Balakumar ◽  
S C Khaw ◽  
P Milne ◽  
S Kini
Keyword(s):  
Breast Cancer ◽  
Cervical Cancer ◽  
Survival Rate ◽  
Fertility Preservation ◽  
Young Women ◽  
Pregnancy Outcomes ◽  
Cancer Survival ◽  
Embryo Cryopreservation ◽  
Utilisation Rate ◽  
The Mean

Abstract Study question The aim of the study was to determine the percentage of patients returning to use their stored eggs/embryos following FP and their pregnancy outcomes. Summary answer The patient utilisation rate for eggs/embryos was 17% with a live birth rate of 59%. What is known already Fertility preservation is considered as a vital issue for individuals in the reproductive stage of life when their future fertility may be compromised. Increased cancer survival rate and advances in assisted reproductive techniques make this an essential service to offer to patients facing life limiting disease or long-term medical conditions.FP is important to improve the quality of life in cancer survivors. Study design, size, duration A retrospective analysis was performed over a period of ten years between January 2010 to December 2020 in our tertiary unit. A total of 75 patients who underwent FP were identified. Participants/materials, setting, methods Infertility database for embryology and andrology (IDEAS) was used for the data collection and analysis. Patient’s age, reasons for fertility preservation, type of benign/cancer condition, protocol used for controlled ovarian stimulation (COS), dose of the gonadotropins, number of eggs collected, number of eggs/embryos cryopreserved, duration between storage and fertility treatment, pregnancy outcomes were included in the analysis. Main results and the role of chance Seventy-five patients underwent FP during the 10-year study period. The mean age was 30 years (range 17–43). Seventy-two patients (96%) underwent treatment for oncological reasons and the rest (4%) were for gender transition and Crohn’s disease. The most common types of malignancies include breast cancer (36%), Hodgkin’s lymphoma (18%) and cervical cancer (15%). Ninety-two percentage of patients underwent COS with an antagonist cycle, with an average of 10.8 eggs collected. Recombinant follicle stimulating hormone (FSH) was used in 92% of the cycles and human menopausal gonadotropin (HMG) was used in 8%. Fifty-eight percentage were given a maximum dose of 300IU of gonadotropin. The mean yield of eggs was higher in patients with breast cancer (12.62) followed by Hodgkin’s (10.5) and cervical cancer (9.6). Majority (60%) had embryo cryopreservation (82% at blastocyst stage and 18% at day 3 cleavage stage) and the rest (40%) had egg cryopreservation. A total of 17% (12) of patients returned for treatment with a livebirth rate of 59% and miscarriage rate of 8%. One third of livebirths were achieved through surrogacy. The average duration between fertility preservation and return for treatment was 2.4 years. Limitations, reasons for caution During the last 5 years, there has been an increase in the number of young women requiring FP in our unit. These women may require a considerable amount of time to complete their oncological treatment before embarking on pregnancy using their stored eggs/embryos. Wider implications of the findings: As cancer survival rate improves, there will be a likely increase in the utilisation rate for follow up treatment among young women who had FP. The overall awareness of the gonadotoxic effect of cancer therapy and available fertility preservation options among both patients and clinicians needs to be increased. Trial registration number NA

The importance of fertility preservation in women with early breast cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20663-e20663
Author(s):  
A. Agbarya ◽  
S. Linn
Keyword(s):  
Breast Cancer ◽  
Fertility Preservation ◽  
Young Women ◽  
Large Scale ◽  
Breast Cancer Survivors ◽  
Early Stage ◽  
Young Patients ◽  
Future Research ◽  
Medical Procedure ◽  
Young Breast Cancer

e20663 Background: Young women with breast cancer often seek advice regarding treatment effects on their fertility. The purpose of this study was to gain a better understanding of women's attitudes to fertility and how these concerns affect decision-making. Methods: A survey on fertility issues was developed for young women with a history of early-stage breast cancer. The survey was completed by direct interviews with the patients. Results: Eighty-four eligible respondents completed the survey. Mean age at breast cancer diagnosis was 34.7 years. Fifty-seven percent of the women were Jewish and 43% were Arabic; 71% were married; 75% had more than 12 years of education. Stages at diagnosis were: I - 51%; II - 38%; III - 11%. Seventy-seven percent of the women were within six months of diagnosis and 49% reported substantial concern about becoming infertile with treatment. In multivariate logistic regression, a greater concern about infertility was associated with a wish for children (p=0.0008), number of children less than three (p=0.001), more than 12 years of education (p=0.004), and a moderate or high level of fear of treatment (p=0.004). Seventy-nine percent of patients reported discussing fertility concerns with their doctors, and 14% underwent a medical procedure for fertility preservation. Only five patients stated that infertility concerns influenced their treatment decisions. Conclusions: 1. Fertility after treatment is a major concern for young breast cancer patients undergoing chemotherapy. 2. This statement was not affected by ethnicity. 3. There is a need to communicate with and educate young patients regarding fertility issues and large scale future research directed at preserving fertility for young breast cancer survivors is warranted. No significant financial relationships to disclose.

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

2014 ◽  
Vol 32 (11) ◽  
pp. 1151-1156 ◽  
Author(s):  
Kathryn J. Ruddy ◽  
Shari I. Gelber ◽  
Rulla M. Tamimi ◽  
Elizabeth S. Ginsburg ◽  
Lidia Schapira ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Fertility Preservation ◽  
Endocrine Therapy ◽  
Young Women ◽  
Early Stage ◽  
Treatment Decisions ◽  
Baseline Survey ◽  
Newly Diagnosed ◽  
Multicenter Cohort Study ◽  
To Receive

Purpose Most 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 Methods As part of an ongoing prospective multicenter cohort study, we surveyed women with newly diagnosed early-stage breast cancer at age ≤ 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 < 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. Conclusion Many 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.

scholarly journals Treatment-related amenorrhea in a modern, prospective cohort study of young women with breast cancer

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Philip D. Poorvu ◽  
Jiani Hu ◽  
Yue Zheng ◽  
Shari I. Gelber ◽  
Kathryn J. Ruddy ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Fertility Preservation ◽  
Prospective Cohort Study ◽  
Young Women ◽  
Prospective Cohort ◽  
Ovarian Function ◽  
Future Research ◽  
Normal Body Mass Index ◽  
Clinical Trial Registration

AbstractYoung women with breast cancer experience unique treatment and survivorship issues centering on treatment-related amenorrhea (TRA), including fertility preservation and management of ovarian function as endocrine therapy. The Young Women’s Breast Cancer Study (YWS) is a multi-center, prospective cohort study of women diagnosed at age ≤40, enrolled from 2006 to 2016. Menstrual outcomes were self-reported on serial surveys. We evaluated factors associated with TRA using logistic regression. One year post-diagnosis, 286/789 (36.2%) experienced TRA, yet most resumed menses (2-year TRA: 120/699; 17.2%). Features associated with 1-year TRA included older age (OR≤30vs36-40 = 0.29 (0.17–0.48), OR31-35vs36-40 = 0.67 (0.46–0.94), p = 0.02); normal body mass index (BMI) (OR≥25vs18.5-24. =0.59 (0.41–0.83), p < 0.01); chemotherapy (ORchemo vs no chemo = 5.55 (3.60–8.82), p < 0.01); and tamoxifen (OR = 1.55 (1.11–2.16), p = 0.01). TRA rates were similar across most standard regimens (docetaxel/carboplatin/trastuzumab +/− pertuzumab: 55.6%; docetaxel/cyclophosphamide +/− trastuzumab/pertuzumab: 41.8%; doxorubicin/cyclophosphamide/paclitaxel +/− trastuzumab/pertuzumab: 44.1%; but numerically lower with AC alone (25%) or paclitaxel/trastuzumab (11.1%). Among young women with breast cancer, lower BMI appears to be an independent predictor of TRA. This finding has important implications for interpretation of prior studies, future research, and patient care in our increasingly obese population. Additionally, these data describe TRA associated with use of docetaxel/cyclophosphamide, which is increasingly being used in lieu of anthracycline-containing regimens. Collectively, these data can be used to inform use of fertility preservation strategies for women who need to undergo treatment as well as the potential need for ovarian suppression following modern chemotherapy for young women with estrogen-receptor-positive breast cancer.Clinical trial registration: www.clinicaltrials.gov, NCT01468246.

Characterizing attitudes related to child-bearing in young women diagnosed with early breast cancer (EBC).

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 165-165
Author(s):  
Saumya Umashankar ◽  
Moming Li ◽  
Mi-Ok Kim ◽  
Hope S. Rugo ◽  
Michelle E. Melisko ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Young Women ◽  
Care Center ◽  
Baseline Survey ◽  
Full Time ◽  
Incurable Cancer ◽  
Receptor Status ◽  
Child Bearing ◽  
Future Child ◽  
Increasing Risk

165 Background: Young women diagnosed with breast cancer face unique challenges. The desire to have a biologic child (bchild) is often a factor in treatment decisions at diagnosis and follow-up. The aim of this study is to characterize the intentions, attitudes, and decision factors considered by young women who desire to have a bchild after a diagnosis of EBC. Methods: This prospective study included young women diagnosed with stage 1-3 EBC under age 45 who saw an oncologist at UCSF’s Breast Care Center (BCC). Young women < 6 months from diagnosis were invited to complete a baseline REDCap survey on fertility, child-bearing, and family-building. Descriptive statistics were used to summarize responses. Chi square and independent samples t tests were used to compare demographics. Covariates were analyzed using odds ratios. Results: From Feb 2018 to Dec 2020, 166 eligible pts seen at the UCSF BCC were contacted, 143 pts consented, and 108 (75.5%) completed the baseline survey. Of the 108 pts, 57 (53%) were interested in having a bchild in the future. Age was the biggest driver of whether participants were interested in future child-bearing vs. not (Mean = 35.4 vs 40.9, p < 0.001) and was not influenced by stage, receptor status, or treatment. 73.6% (N = 42) of those interested in future child-bearing underwent or planned to undergo fertility preservation (FP). FP was associated with full time employment (p = 0.03) and higher education (p = 0.02). Of the 57 pts interested in future child-bearing (42 HR+, 11 TN, 12 HER2+), 30% wished to start trying to conceive within 2 years from diagnosis, and only 20% would wait 5 years or more. 43% (N = 18) of those with HR+ disease were willing to complete 5 years of hormone therapy (HT) before trying to conceive. Given hypothetical risk scenarios of an incurable cancer recurrence, 16.3% of participants were interested in a future bchild despite a 75-100% hypothetical risk of recurrence (ROR). Young women self-identified as Asian were less inclined to pursue child-bearing with increasing risk (OR = 0.3 vs. Caucasian, p = 0.04), while BRCA-carriers were more likely to remain interested in future child-bearing despite increasing risk (OR = 6.43 vs. non-carriers, p = 0.03). 59% would stop adjuvant HT early if the hypothetical absolute increased ROR from early discontinuation was < 10%. Conclusions: In this single-institution study, over half of young women with EBC expressed a desire to have a future bchild. This was independent of stage, receptor status, and treatment; the majority of women wished to conceive < 5 years from diagnosis. The desire for a future bchild decreased with increasing hypothetical risk of incurable recurrence; however, a subset wished to attempt child-bearing even when an incurable recurrence was certain. Having a bchild after EBC is a priority for many young women and should be addressed at diagnosis and throughout the continuum of care.

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