scholarly journals Knowledge, Practice, and Attitudes of Physicians in Low- and Middle-Income Countries on Fertility and Pregnancy-Related Issues in Young Women With Breast Cancer

2022 ◽  
Author(s):  
Shah Zeb Khan ◽  
Luca Arecco ◽  
Cynthia Villarreal-Garza ◽  
Bhawna Sirohi ◽  
Noam F. Ponde ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Fertility Preservation ◽  
Young Women ◽  
Ovarian Tissue ◽  
Ovarian Tissue Cryopreservation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Knowledge Practice ◽  
Tissue Cryopreservation ◽  
Low And Middle Income

PURPOSE Fertility and pregnancy-related issues are highly relevant for young (≤ 40 years) patients with breast cancer. Limited evidence exists on knowledge, practice, and attitudes of physicians from low- and middle-income countries (LMICs) regarding these issues. METHODS A 19-item questionnaire adapted from an international survey exploring issues about fertility preservation and pregnancy after breast cancer was sent by e-mail between November 2019 and January 2020 to physicians from LMICs involved in breast cancer care. Descriptive analyses were performed. RESULTS A total of 288 physicians from Asia, Africa, America, and Europe completed the survey. Median age was 38 years. Responders were mainly medical oncologists (44.4%) working in an academic setting (46.9%). Among responders, 40.2% and 53.8% reported having never consulted the available international guidelines on fertility preservation and pregnancy after breast cancer, respectively. 25.0%, 19.1%, and 24.3% of responders answered to be not at all knowledgeable about embryo, oocyte, or ovarian tissue cryopreservation, respectively; 29.2%, 23.6%, and 31.3% declared that embryo, oocyte, and ovarian tissue cryopreservation were not available in their countries, respectively. 57.6% of responders disagreed or were neutral on the statement that controlled ovarian stimulation can be considered safe in patients with breast cancer. 49.7% and 58.6% of responders agreed or were neutral on the statement that pregnancy in breast cancer survivors may increase the risk of recurrence overall or only in those with hormone receptor–positive disease, respectively. CONCLUSION This survey showed suboptimal knowledge, practice, and attitudes of physicians from LMICs on fertility preservation and pregnancy after treatment completion in young women with breast cancer. Increasing awareness and education on these aspects are needed to improve adherence to available guidelines and to promote patients' oncofertility counseling.

Spontaneous Pregnancy and Fertility Preservation Program in Women Undergoing High Dose Chemotherapy for Hematological Malignancies.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1114-1114
Author(s):  
Izhar Hardan ◽  
Dror Meirow ◽  
Avichai Shimoni ◽  
Jacob Levron ◽  
Noga Shemtov ◽  
...  
Keyword(s):  
Fertility Preservation ◽  
Young Women ◽  
Ovarian Tissue ◽  
Young Patients ◽  
High Dose Chemotherapy ◽  
Ovarian Failure ◽  
Ovarian Tissue Cryopreservation ◽  
High Dose ◽  
Cryopreserved Ovarian Tissue ◽  
Tissue Cryopreservation

Abstract Loss of fertility is a major concern in young women undergoing high dose chemotherapy (HDT). Although it is generally accepted that therapy of the myeloabelative range is related with a high rate of fertility loss, we observed during the last years eight spontaneous pregnancies with normal deliveries in young women after bone marrow transplantation. Seven patients (pt’s) were with lymphoma and MM and were conditioned with BEAM regimen (n=6) and melphalan 200mg/sm (n=1) prior to an autologous SCT, while one patient had a secondary AML and underwent BEAM primed autologous SCT and Busulfex/FA primed allogeneic BMT. The median age at transplant of this group was 28y and median time from transplant to pregnancy was 25 months. More than 100 women of 18–40y.o were transplanted in our center during this period; however, obviously the fertility rate cannot be calculated as it is related with additional parameters including survival, post transplant complications and mainly patient’s preferences. Naturally we observed during the same period many young patients with ovarian failure post transplant, as well as one successful pregnancy from a cryopreserved embryo. Methods. We Therefore initiated in October 2000 a fertility preservation program in which all women of 18 – 40y.o were offered a pretransplant IVF with embryo preservation, and/or ovarian tissue cryopreservation (OTC), according to their clinical status. 651 pt’s were transplanted in our center in the last 44 months, of which 81 were women of 18–41y.o that were all enrolled in this program. Results. Seven pt’s of this group (8.6%) underwent IVF. The major causes of denying IVF were the need to delay BMT for more than clinically accepted, prolonged preexisting ovarian failure, lack of a suitable partner and patient’s preference. Seventeen pt’s (21%) underwent OTC. The major causes of denying OTC were patient’s preference (mainly due to no evidence of success with this method) and thrombocytopenia/neutropenia. During this period: One patient of this group was fertilized with her cryopreserved embryos 32 months after transplant and is at her 16 week of pregnancy. One patient underwent a successful transplantation of her cryopreserved ovarian tissue 2.5 years after HDC while in a documented ovarian failure, and gave birth to a healthy baby on June 2005. The OTC of this patient was performed after cis-platinum containing salvage therapy for relapsing NHL, prior to BEAM primed SCT, and immediately after a failure of hormonal stimulation for IVF. One patient underwent a cryopreserved ovarian tissue transplantation on July 2005 Conclusions: 1. Spontanous pregnancy after HDT, mainly at the younger age, is not a rare phenomenon. 2. Most young patients prior to HDT are not eligible for IVF. 3. Pretransplant ovarian tissue cryopreservation is a feasible tool in this set-up. The first success with this method is promising.

scholarly journals Fertility preservation for girls and young women with cancer: population-based validation of criteria for ovarian tissue cryopreservation

2014 ◽  
Vol 15 (10) ◽  
pp. 1129-1136 ◽  
Author(s):  
W Hamish B Wallace ◽  
Alice Grove Smith ◽  
Thomas W Kelsey ◽  
Angela E Edgar ◽  
Richard A Anderson
Keyword(s):  
Fertility Preservation ◽  
Young Women ◽  
Ovarian Tissue ◽  
Population Based ◽  
Ovarian Tissue Cryopreservation ◽  
Tissue Cryopreservation

Fertility preservation options and the young breast cancer patient: A survey.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 575-575
Author(s):  
Manuela Jacobsen Junqueira ◽  
Shari Beth Goldfarb ◽  
Bridget A. Oppong ◽  
Sujata Patil ◽  
Anne Eaton ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Pilot Study ◽  
Fertility Preservation ◽  
Young Women ◽  
Ovarian Tissue ◽  
Ovarian Tissue Cryopreservation ◽  
Breast Cancers ◽  
Graduate Degree ◽  
Newly Diagnosed ◽  
Young Breast Cancer

575 Background: Approximately 15% of breast cancers (BC) are diagnosed in reproductive aged women. Management of the disease in this age group frequently includes chemotherapy and hormonal therapy, which can both affect fertility. Considering that age at first delivery has been steadily increasing, young women may face BC before completion of childbearing. Methods: In this prospective study, women referred to our institution for surgical treatment of BC were asked, before their first visit, to fill out a questionnaire regarding their reproductive history and fertility preservation knowledge. Eligible patients included women between the ages of 18 and 45, with a newly diagnosed BC, who had not yet started treatment. Results: Sixty women were eligible with a median age of 40 (range 20-45). 98% of responders (59 out of 60) had been diagnosed within the previous 2 months. 78% (47/60) had a college or post-graduate degree. 80% (48/60) had been pregnant before, while 86.5% (45/52) reported having had children. 81% (47/58) were premenopausal, and only 3 patients reported not having had periods for more than 1 year. 50% of responders (30/60) declared no interest in future childbearing, 25% were definitely interested, and 25% were undecided. However, only 9% (5/57) reported having received information on fertility preservation options before the survey. Women who have been pregnant were significantly less likely to consider fertility preservation options prior to treatment (egg/embryo/ovarian tissue cryopreservation [6% vs. 50%, p=0.001]), or after treatment (egg/embryo donation, surrogacy or adoption [6% vs. 58%, p<0.0001]). Conclusions: This pilot study was designed to gather information on reproductive health of newly diagnosed young BC patients and to assess their willingness to consider various fertility preservation options before or after treatment. Our study population consisted of mostly women who had been pregnant and had children. We found that 50% of the women were unsure or wanted future children. Yet, only 9% had received information on fertility options at diagnosis. This pilot study highlights the need for education and/or intervention in fertility preservation options for young women with breast cancer.

scholarly journals Ovarian Tissue Cryopreservation in a Patient with Breast Cancer During Pregnancy: A Case Report

2021 ◽  
Author(s):  
Jiaojiao Cheng ◽  
Xiangyan Ruan ◽  
Juan Du ◽  
Fengyu Jin ◽  
Yanglu Li ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Targeted Therapy ◽  
Neoadjuvant Chemotherapy ◽  
Fertility Preservation ◽  
Ovarian Tissue ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Ovarian Tissue Cryopreservation ◽  
Tissue Cryopreservation

Abstract Background: Fertility preservation using ovarian tissue cryopreservation (OTC) in patients with certain diseases especially needing chemo- or radiotherapy is becoming a routine management in various Western countries. Our hospital is the first and until now the only center in China using this method. The question is controversial, if treatment of breast cancer during pregnancy (PrBC) should be similar like for non-pregnant young patients with breast cancer. To our knowledge this worldwide is the first report using OTC as fertility preservation for PrBC. Case presentation: During the 29th week of the pregnancy of a 24-year-old woman needle aspiration cytology of a left breast tumor showed cancer cells. The ultrasound revealed BI-RADS 4a grade. Oncologists recommended the termination of pregnancy. Cesarean section at week 32 was performed, and ovarian tissue samples were collected for OTC to preserve fertility and ovarian endocrine function. Twenty-three ovarian cortex slices were slowly programmed cryopreserved. It is estimated that 13000 follicles have been cryopreserved. Breast nodules and sentinel lymph node biopsy suggested invasive micropapillary carcinoma. Neoadjuvant chemotherapy within 1 week after diagnosis was started. After six courses of neoadjuvant chemotherapy, targeted drug therapy, and Goselin acetate, left mastectomy and left axillary lymph node dissection were performed. In total twenty-three times of radiotherapy, eight trastuzumab targeted therapy, and 17 pertuzumab + trastuzumab double targeted therapy was performed after breast cancer surgery. Until now, more than two years after delivery the ovarian function still is good. We do not see any signs of a negative impact of OTC. The injections of goserelin acetate, every 28 days, are planned to last for the next five years. In addition endocrine therapy with anastrozole, started after the breast cancer surgery, also is scheduled for five years. Conclusion: OTC for fertility preservation in patients with PrBC does not delay breast surgery, radiotherapy, or chemotherapy which is essential for an effective treatment of breast cancer. We assess this method as a promising fertility preservation method, worldwide for the first time now also used in a patient getting breast cancer in pregnancy.

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

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Jiaojiao Cheng ◽  
Xiangyan Ruan ◽  
Juan Du ◽  
Fengyu Jin ◽  
Yanglu Li ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Targeted Therapy ◽  
Neoadjuvant Chemotherapy ◽  
Fertility Preservation ◽  
Ovarian Tissue ◽  
Breast Cancer Surgery ◽  
Ovarian Tissue Cryopreservation ◽  
Goserelin Acetate ◽  
Tissue Cryopreservation

Abstract 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.

scholarly journals Breast Cancer in Low- and Middle-Income Countries: An Emerging and Challenging Epidemic

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Arafat Tfayli ◽  
Sally Temraz ◽  
Rachel Abou Mrad ◽  
Ali Shamseddine
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Low Income ◽  
Therapeutic Interventions ◽  
Low Income Countries ◽  
Middle Income ◽  
Major Health ◽  
Middle Income Countries ◽  
Low And Middle Income

Breast cancer is a major health care problem that affects more than one million women yearly. While it is traditionally thought of as a disease of the industrialized world, around 45% of breast cancer cases and 55% of breast cancer deaths occur in low and middle income countries. Managing breast cancer in low income countries poses a different set of challenges including access to screening, stage at presentation, adequacy of management and availability of therapeutic interventions. In this paper, we will review the challenges faced in the management of breast cancer in low and middle income countries.

Fertility Preservation

2018 ◽  
Author(s):  
Chantae S Sullivan-Pyke ◽  
Clarisa Gracia
Keyword(s):  
Fertility Preservation ◽  
Ovarian Tissue ◽  
Testicular Tissue ◽  
Mature Oocyte ◽  
Gonadotropin Releasing Hormone ◽  
Oocyte Cryopreservation ◽  
Ovarian Tissue Cryopreservation ◽  
Embryo Cryopreservation ◽  
Gonadotropin Releasing Hormone Agonist ◽  
Tissue Cryopreservation

Fertility preservation has becoming increasingly important for patients at risk for gonadal failure, including those needing treatment for cancer or autoimmune conditions, genetic conditions that predispose to gonadal insufficiency, and age-related fertility decline. Embryo cryopreservation and mature oocyte cryopreservation are the standards for fertility preservation in postpubertal women. Ovarian tissue cryopreservation and gonadotropin-releasing hormone agonist use for ovarian suppression are experimental methods that may be offered to patients for whom embryo and/or mature oocyte cryopreservation are not applicable. The cryopreservation of spermatozoa is the standard for fertility preservation in postpubertal males, but testicular tissue cryopreservation may be offered to prepubertal males.   This review contains 10 figures, 6 tables and 53 references Key words: controlled ovarian stimulation, embryo cryopreservation, gonadotropin-releasing hormone agonist, in vitro maturation, oocyte cryopreservation, ovarian tissue cryopreservation, sperm extraction, testicular tissue cryopreservation  

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