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.

Trends in breast cancer incidence among young women aged 20 to 49 years in the United States.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10573-10573
Author(s):  
Shuai Xu ◽  
Yunan Han ◽  
Fei Wan ◽  
Adetunji T. Toriola
Keyword(s):  
Breast Cancer ◽  
Young Women ◽  
Cancer Incidence ◽  
Invasive Breast Cancer ◽  
Hormone Receptor ◽  
Breast Cancer Incidence ◽  
Tumor Stage ◽  
Hormone Receptor Status ◽  
Receptor Status ◽  
Race Ethnicity

10573 Background: Breast cancer in young women is diagnosed at more advanced stages and has a less favorable prognosis. We investigated trends in breast cancer incidence by race/ethnicity, hormone receptor status, and tumor stage in women aged 20-49 years over the past 25 years, as well as the impact of period and cohort effects on these trends. Methods: We used data from Surveillance, Epidemiology, and End Results (SEER) 13 registries for 1993-2002 and SEER 18 registries for 2003-2017. We calculated age-standardized incidence rates and annual percent change (APC), and stratified by race/ethnicity, hormone receptor status (estrogen receptor [ER] and progesterone receptor [PR]), and tumor stage (I-IV) for 222,424 women aged 20-49 years with a primary invasive breast cancer. We performed age-period-cohort analysis (presented as incidence rate ratios [IRR]) to investigate the effects of age, period, and cohort on incidence trends using the 1948 cohort and 1993-1997 period as the reference groups, respectively. Results: Between 2010-2017, invasive breast cancer incidence increased (APC = 0.67%, 95%CI: 0.32 to 1.03) among women aged 20-49 years, after being stable from 1993-2010. There were differences by race over the 25-year period (1993-2017). We observed significant increases in incidence among non-Hispanic White (NHW) (APC = 0.25%, 95%CI: 0.16 to 0.34), non-Hispanic Asia/Pacific Islander (NHAPI) (APC = 0.58%, 95%CI: 0.34 to 0.82), and Hispanic women (APC = 0.59%, 95%CI: 0.34 to 0.83), but not among non-Hispanic black (NHB) women (APC = 0.14%, 95%CI: -0.06 to 0.34). Incidence increased for ER+ tumors but decreased for ER- tumors: ER+/PR+ (APC = 2.39%, 95%CI: 2.20 to 2.58), ER+/PR- (APC = 1.46%, 95%CI: 1.05 to 1.87), ER-/PR+ (APC = -6.33%, 95%CI: -7.31 to -5.33), and ER-/PR- (APC = -0.70%, 95%CI: -1.09 to -0.32). The decrease in ER-/PR- tumors appeared largely driven by decreases among HNW women. Incidence for stages I (APC = 0.31, 95%CI: 0.07 to 0.55), II (APC = 0.99, 95%CI: 0.82 to 1.16), and IV (APC = 2.88, 95%CI: 2.37 to 3.39) tumors increased while that for stage III tumors decreased (APC = 0.81%, 95%CI: -1.04 to -0.59). Both the cohort and period effects impacted incidence, with the cohort effect almost 10 times larger than the period effect. Age-specific relative risk by birth cohort initially decreased between 1948 and 1958 but steadily increased from 1958 to 1993. Breast cancer incidence was higher among women born in the 1988 (IRR = 1.17, 95%CI: 1.07 to 1.28) and 1993 (IRR = 1.22, 95%CI: 0.99 to 1.51) cohorts than for those born in 1948 cohort. Conclusions: Breast cancer incidence is increasing among young women, mainly driven by increases in ER+ tumors. Prevention efforts need to focus on how we can address factors driving the increase in ER+ tumors and also learn from what has worked for decreasing ER- tumors.

Quality of life and psychosocial distress in young women with advanced breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20508-e20508
Author(s):  
Davinia Shien Seah ◽  
Shari Gelber ◽  
Kathryn Jean Ruddy ◽  
Rulla M. Tamimi ◽  
Lidia Schapira ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
General Population ◽  
Young Women ◽  
Bodily Pain ◽  
Psychosocial Distress ◽  
Baseline Survey ◽  
Factors Associated ◽  
Sf 36

e20508 Background: Little is known about the quality of life (QOL), prevalence and predictors of psychosocial distress in young women with advanced breast cancer (ABC). Methods: As part of an ongoing longitudinal multi-center study of women aged < 40 with newly diagnosed breast cancer, we identified women with ABC. Using baseline survey and medical chart data, we assessed QOL (measured by the Medical Outcomes Study Short Form-36 [SF-36], with norm based means [NBM] <47 indicating a clinically meaningful worsening QOL compared to the general population), and evaluated relationships between demographic and clinical variables and psychosocial distress (measured by the Hospital Anxiety and Depression Scale [HADS], with higher scores indicating more distress). Demographic and clinical factors were tested in univariate models. Factors with a p < 0.2 were evaluated in multivariate models to determine factors associated with anxiety or depression (HADS subscale scores >11). Results: Of the 725 women who completed a baseline survey, 40 had ABC. Median age of ABC diagnosis was 37 (range 23-40). Median time between diagnosis and survey completion was 143 days. Other than general health (NBM 56.8) and role limitations due to emotional problems (NBM 53.8), SF-36 subscale scores of young women with ABC were lower compared to the general population, especially, bodily pain (NBM 27.4), social functioning (NBM 33.5) and mental health (NBM 44.3) scores. Physical and mental component summary NBM scores were 44.3 and 45.8 respectively. 30% (12/40) were anxious and 10% (4/40) were depressed according to HADS. The 4 depressed women also met criteria for anxiety. Women who were more financially comfortable were less anxious (OR 0.07, p=0.04). Logistic regression identified no other factors associated with anxiety, and no factors were associated with depression. Conclusion: QOL is impaired in young women with recently diagnosed ABC, particularly from bodily pain and disruption to social functioning. Many young ABC patients are anxious, while few are depressed. This study will be expanded to include young women who progressed to ABC. Further research is warranted to evaluate interventions to improve QOL and psychosocial distress in this population.

scholarly journals Risk factors for breast cancer in young women by oestrogen receptor and progesterone receptor status

2003 ◽  
Vol 89 (9) ◽  
pp. 1661-1663 ◽  
Author(s):  
M R E McCredie ◽  
G S Dite ◽  
M C Southey ◽  
D J Venter ◽  
G G Giles ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Progesterone Receptor ◽  
Young Women ◽  
Oestrogen Receptor ◽  
Progesterone Receptor Status ◽  
Receptor Status

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.

Diagnostic and treatment delays in young women with breast cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6575-6575
Author(s):  
Philip D Poorvu ◽  
Yue Zheng ◽  
Tal Sella ◽  
Shoshana M. Rosenberg ◽  
Kathryn Jean Ruddy ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Young Women ◽  
Underserved Populations ◽  
Post Partum ◽  
Signs And Symptoms ◽  
Baseline Survey ◽  
Factors Associated ◽  
Breast Cancer Study ◽  
Additional Support ◽  
Stage 1

6575 Background: Delays in diagnosis (dx) and treatment (tx) affect breast cancer (BC) outcomes. We sought to identify factors associated with delays among young women, who do not undergo routine screening and often have pregnancy or breastfeeding-related breast changes that may mask a BC. Methods: The Young Women’s Breast Cancer Study is a multicenter, prospective cohort that enrolled 1302 women with newly dx BC age ≤40 between 2006-2016. Women reported the method and timing of cancer detection on the baseline survey. 231 were ineligible or excluded due to missing information. Among those reporting self-detected cancers, using multivariable regression we evaluated factors associated with delays ≥90 days (d) from symptom to presentation (self delay) and presentation to dx (care delay); in stage 0-III BC we evaluated delays ≥60d from dx to tx (tx delay). Results: 1071 eligible women had median age at dx of 37 yrs (17-40) and 74% reported self-detected cancers. Self delay or care delay ≥90d was reported in 17% and 13%, respectively. Factors inversely associated with self delay included pregnancy at dx (vs nulliparous, OR 0.10, CI 0.01-0.78) and perceived financial comfort (vs not, OR 0.62, CI 0.41-0.93). Women dx ≤1 year post-partum who breastfed (vs nulliparous, OR 2.60, CI 1.14-5.93) and those with a family history of breast/ovarian cancer (vs none, OR 1.79, CI 1.00-3.19) were more likely to have a care delay. Age was inversely associated with care delays (OR 0.94, CI 0.89-0.99). Tx delay was reported by 10% (105/1015), and associated with being single (vs partnered, OR 1.61, CI 1.02-2.56 ), non-white (vs white, OR 1.85, CI 1.09-3.13) and having Stage 0 BC (vs stage 1, OR: 3.08, CI 1.65-5.77); women with stage 3 BC (vs stage 1, OR 0.13, CI 0.03-0.56) were less likely to have a tx delay. Conclusions: In this cohort, most young women with BC underwent timely dx and tx initiation. Women dx ≤1 year post-partum who breastfed were more likely to experience a care delay, likely because lactational changes may mask BC signs and symptoms. The associations of perceived financial status with self delay and non-white race with tx delay underscore the need for additional support to ensure timely care for underserved populations with the goal of eliminating disparities in outcomes.

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.

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