Case Report: Young Adults With Breast Cancer: A Case Series of Fertility Preservation Management and Literature Review

Breast cancer comprised at least 21.8% of the overall cancer among young adult (YA) women and became the leading cancer in this group in Japan, with 50% adolescent and YAs being diagnosed and 15–44-year-old women showing excellent 5-year survival. Surgical-chemoradiation therapy often results in excellent survivorship with an increased incidence of treatment-induced subfertility. Therefore, adding fertility preservation (FP) to the primary cancer treatment is necessary. Herein, we reported a series of cases of YA women with breast cancer who opted for FP, where their option was tailored accordingly. To date, the selection of oocytes, embryos and ovarian tissue is widely available as an FP treatment. PGT could reduce the risk of BRCA mutation transmission amongst BRCA carriers before pregnancy planning. Otherwise, gonadotropin-releasing hormone analog has no gonadoprotective effect and thus should not be considered as an FP option.

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Case series: Breast and ovarian cancer syndrome

10.1055/s-0039-1685348 ◽

2016 ◽

Keyword(s):

Breast Cancer ◽

Ovarian Cancer ◽

Brca Mutation ◽

Family Members ◽

Case Series ◽

Second Primary ◽

Time Interval ◽

Breast And Ovarian Cancer ◽

Ovarian Carcinomas ◽

Increased Risk

Aims and Objectives: To report a series of cases with breast and ovarian carcinomas either in same patient or in a family and identifying the importance of BRCA 1,2 genetic testing in such individuals. Materials and Methods: The medical records of breast and ovarian cancer patients operated over past 3 years at a single institute were reviewed retrospectively and their clinical profile, family history, final pathological reports and follow up data was collected. Results: 8 patients were found to have breast and ovarian malignancies, out of which 3 had synchronous breast and ovarian cancers, 4 had metachronous and 1 patient with ovarian cancer had history of breast cancer in family. Median age of presentation to the hospital was 47 years and median time interval in metachronous disease patients was 5.5 years. Conclusion: About 5% of people who have breast cancer and about 10% of women who have ovarian cancer have HBOC, caused by germline mutation in BRCA1, 2 gene. These individuals have increased risk of developing breast cancer at younger age, TNBC, or developing a second primary in breast or ovary plus an overall risk of breast/ovarian/prostate/pancreatic malignancies in other family members due to inheritable mutation. Identification of BRCA mutation in such individuals can help family members to undergo genetic counseling and follow different screening and prevention guidelines from general population thus reducing the cancer risks.

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Fertility Preservation

10.2310/obg.19100 ◽

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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Role of Gonadotropin-Releasing Hormone Analog in the Management of Male Metastatic Breast Cancer Is Uncertain

Journal of Clinical Oncology ◽

10.1200/jco.2007.13.0583 ◽

2007 ◽

Vol 25 (24) ◽

pp. 3787-3787 ◽

Cited By ~ 9

Author(s):

Nan Soon Wong ◽

Wei Seong Ooi ◽

Kathleen I. Pritchard

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Metastatic Breast ◽

Gonadotropin Releasing Hormone ◽

Releasing Hormone ◽

Hormone Analog

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O-180 Oocyte vitrification for fertility preservation does not delay the initiation of neoadjuvant chemotherapy for breast cancer

Human Reproduction ◽

10.1093/humrep/deab127.081 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

I Sellami ◽

M Grynberg ◽

A Benoit ◽

C Sifer ◽

A Mayeur ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Fertility Preservation ◽

Cancer Diagnosis ◽

Ovarian Tissue ◽

Young Patients ◽

Oocyte Retrieval ◽

Breast Cancer Patients ◽

Oocyte Vitrification

Abstract Study question Does oocyte vitrification for fertility preservation (FP) delay the initiation of neoadjuvant chemotherapy for breast cancer? Summary answer The indication of neoadjuvant chemotherapy for breast cancer should not be considered as an impediment to urgent oocyte vitrification for FP. What is known already FP is considered as one of the most important issues to address for young breast cancer patients. Cryopreservation of oocytes or embryos may be considered after controlled ovarian hyperstimulation (COH) or in vitro maturation (IVM). Pregnancies have been reported after reutilization of oocytes frozen following both procedures. Although oocyte competence is better after COH, this strategy requires on average 13 days to be achieved. In addition, the safety of ovarian stimulation before tumor removal is currently not formally established. In case of neoadjuvant chemotherapy, the risk-benefit balance of COH is not well known. Study design, size, duration Retrospective cohort study including all breast cancer patients eligible for oocyte vitrification following COH or IVM before initiation of neoadjuvant chemotherapy between January 2016 and December 2020. Participants/materials, setting, methods Inclusion criteria were: female patients with confirmed non metastatic breast cancer, 18 to 40 years of age, with indication of neoadjuvant chemotherapy, who have had oocyte retrieval for FP after COH or IVM +/- cryopreservation of ovarian tissue. Various time-points related to cancer diagnosis, FP or chemotherapy were obtained from medical record review. Main results and the role of chance A total of 198 patients with confirmed breast cancer who had oocyte retrieval following COH (n = 57) or IVM +/- cryopreservation of ovarian tissue (n = 141) for FP prior to neoadjuvant chemotherapy were included. Although women in IVM group were significantly younger as compared to patients who underwent COH (31.7 ± 4.2 vs. 33.3 ± 4.0 years, p = 0.019), ovarian reserve parameters, BMI and cancer stage did not differ between the two groups. Overall, the average time from cancer diagnosis to chemotherapy start was similar between patients having undergone COH or IVM before oocyte vitrification (37.3 ± 13.8 vs. 36.9 ±13.5 days in COH and IVM groups respectively, p=0.857). Limitations, reasons for caution The time from referral to FP consultation may have influenced the type of FP. In addition, the retrospective nature of the present analysis may constitute a limitation. Moreover, the efficiency and security of the different FP strategies used has not been analysed. Wider implications of the findings Oocyte vitrification following COH or IVM was not associated with delayed breast cancer treatment in the neoadjuvant setting, so long as there was a prompt FP referral. Young patients undergoing neoadjuvant chemotherapy should be informed of these findings to avoid unnecessary anxiety due to concern for delays. Trial registration number Not applicable

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Evaluation of quantitative polymerase chain reaction markers for the detection of breast cancer cells in ovarian tissue stored for fertility preservation

Fertility and Sterility ◽

10.1016/j.fertnstert.2015.04.036 ◽

2015 ◽

Vol 104 (2) ◽

pp. 410-417.e4 ◽

Cited By ~ 6

Author(s):

Laurence Bockstaele ◽

Selma Boulenouar ◽

Géraldine Van Den Steen ◽

Julie Dechène ◽

Sophie Tsepelidis ◽

...

Keyword(s):

Breast Cancer ◽

Polymerase Chain Reaction ◽

Cancer Cells ◽

Fertility Preservation ◽

Breast Cancer Cells ◽

Ovarian Tissue ◽

Quantitative Polymerase Chain Reaction ◽

Chain Reaction ◽

Polymerase Chain

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Fertility Preservation in Women With Endometriosis

Clinical Medicine Insights Reproductive Health ◽

10.1177/1179558119873386 ◽

2019 ◽

Vol 13 ◽

pp. 117955811987338 ◽

Cited By ~ 5

Author(s):

Natalia C Llarena ◽

Tommaso Falcone ◽

Rebecca L Flyckt

Keyword(s):

At Risk ◽

Fertility Preservation ◽

Surgical Intervention ◽

Ovarian Tissue ◽

Ovarian Tissue Cryopreservation ◽

Careful Selection ◽

Multiple Levels ◽

Tissue Cryopreservation ◽

Selection Of ◽

Repeat Procedures

Infertility affects 30% to 50% of women with endometriosis. Women with endometriosis are at risk of decreased ovarian reserve, both because of the pathophysiology of the disease and iatrogenic injury resulting from surgical intervention. Fertility preservation must occur at multiple levels, including careful selection of surgical candidates, avoidance of repeat procedures, and meticulous surgical technique. Fertility preservation with oocyte or ovarian tissue cryopreservation may be considered on an individual basis for women with endometriosis, particularly those at risk of bilateral ovarian injury, such as women with bilateral endometriomas.

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Ovarian Function and Fertility Preservation in Breast Cancer: Should Gonadotropin-Releasing Hormone Agonist be administered to All Premenopausal Patients Receiving Chemotherapy?

Clinical Medicine Insights Reproductive Health ◽

10.1177/1179558119828393 ◽

2019 ◽

Vol 13 ◽

pp. 117955811982839 ◽

Cited By ~ 6

Author(s):

Matteo Lambertini ◽

François Richard ◽

Bastien Nguyen ◽

Giulia Viglietti ◽

Cynthia Villarreal-Garza

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Fertility Preservation ◽

Clinical Evidence ◽

Ovarian Function ◽

Gonadotropin Releasing Hormone ◽

Breast Cancer Patients ◽

Premenopausal Breast Cancer ◽

Ovarian Suppression ◽

Gonadotropin Releasing Hormone Agonist

Chemotherapy-induced premature ovarian insufficiency (POI) is one of the potential drawbacks of chemotherapy use of particular concern for newly diagnosed premenopausal breast cancer patients. Temporary ovarian suppression obtained pharmacologically with the administration of a gonadotropin-releasing hormone agonist (GnRHa) during chemotherapy has been specifically developed as a method to counteract chemotherapy-induced gonadotoxicity with the main goal of diminishing the risk of POI. In recent years, important clinical evidence has become available on the efficacy and safety of this strategy that should now be considered a standard option for ovarian function preservation in premenopausal breast cancer patients, including women who are not interested in conceiving after treatment or that would not be candidates for fertility preservation strategies because of their age. Nevertheless, in women interested in fertility preservation, this is not an alternative to gamete cryopreservation, which remains as the first option to be offered. In this setting, temporary ovarian suppression with GnRHa during chemotherapy should be also proposed following gamete cryopreservation or to women who have no access, refuse, or have contraindications to surgical fertility preservation techniques. In this article, we present an overview about the role of temporary ovarian suppression with GnRHa during chemotherapy in breast cancer patients by addressing the available clinical evidence with the aim of identifying both the best candidates for the use of this strategy and the still existing gray zones requiring further investigation.

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The role of gonadotropin-releasing hormone agonists in female fertility preservation

Clinical and Experimental Reproductive Medicine ◽

10.5653/cerm.2020.04049 ◽

2021 ◽

Vol 48 (1) ◽

pp. 11-26

Author(s):

Jae Hoon Lee ◽

Young Sik Choi

Keyword(s):

Cancer Patients ◽

Fertility Preservation ◽

Young Women ◽

Large Scale ◽

Ovarian Tissue ◽

Gonadotropin Releasing Hormone ◽

Ovarian Tissue Cryopreservation ◽

Breast Cancer Patients ◽

Ovarian Suppression ◽

Releasing Hormone

Advances in anticancer treatments have resulted in increasing survival rates among cancer patients. Accordingly, the quality of life after treatment, particularly the preservation of fertility, has gradually emerged as an essential consideration. Cryopreservation of embryos or unfertilized oocytes has been considered as the standard method of fertility preservation among young women facing gonadotoxic chemotherapy. Other methods, including ovarian suppression and ovarian tissue cryopreservation, have been considered experimental. Recent large-scale randomized controlled trials have demonstrated that temporary ovarian suppression using gonadotropin-releasing hormone agonists (GnRHa) during chemotherapy is beneficial for preventing chemotherapy-induced premature ovarian insufficiency in breast cancer patients. It should also be emphasized that GnRHa use during chemotherapy does not replace established fertility preservation methods. All young women facing gonadotoxic chemotherapy should be counseled about and offered various options for fertility preservation, including both GnRHa use and cryopreservation of embryos, oocytes, and/or ovarian tissue.

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