Fertility Concerns Affect Treatment Choices in Young Women With Breast Cancer, but Few Use Preservation Options


Key Points

  • Fertility concerns affected treatment decisions for 26% of patients.
  • Fertility preservation strategies were used by 10% of women.

Little is known about how fertility concerns affect treatment decisions or fertility preservation strategies at the time of initial diagnosis of breast cancer. In an ongoing multicohort study reported in the Journal of Clinical Oncology, Ruddy et al found that most young women with breast cancer discussed fertility issues before starting therapy, that such issues affect treatment decisions in a substantial proportion, and that few women pursue available fertility preservation strategies.

Study Details

The study is part of an ongoing prospective study (Helping Ourselves, Helping Others: The Young Women’s Breast Cancer Study) involving surveys of women with newly diagnosed early-stage breast cancer at age ≤ 40 years. The baseline survey included sociodemographic, medical, and treatment data and a modified Fertility Issues Survey, including fertility concern and preservation items. Patients had to have a diagnosis of stage 0 to IV breast cancer < 6 months before study enrollment.

Among the first 620 eligible respondents included in the analysis, median age was 37 years (range, 17–40 years); 88% were white; 66% had children prior to diagnosis; 6% were no longer menstruating at the time of the survey; disease stage was I in 36%, II in 43%, and III in 13%; disease grade was 2 in 33% and 3 in 58%; and disease was estrogen receptor–positive in 70%, progesterone receptor–positive in 63%, and HER2-positive in 30%; 69% had received or were receiving chemotherapy, 19% were already receiving endocrine therapy, and 54% had received mastectomy.

Survey Results

Overall, 37% and 26% of women wished to have children in the future at time of diagnosis and time of survey, respectively, 68% of women discussed fertility issues with their physician before starting therapy, and 51% were concerned about becoming infertile after treatment. A total of 26% reported that fertility concerns affected their treatment decisions; due to these concerns, 1% chose not to receive chemotherapy, 2% chose one chemotherapy regimen over another, 1% considered not receiving endocrine therapy, 3% decided not to receive endocrine therapy, 11% considered receiving endocrine therapy for < 5 years, and 1% chose to have mastectomy. Overall, 10% of women used fertility preservation strategies, including embryocryopreservation (7%), oocyte cryopreservation (1%), and gonadotropin-releasing hormone use (3%).

On multivariate analysis, greater concern about fertility was associated with younger age (odds ratio [OR] = 0.26, P < .001, for ≥ 35 vs < 35 years), nonwhite race (OR = 0.38, P = .003, for white vs not white), not having children (OR = 0.17, P < .001, for has children vs does not have children), and receipt of chemotherapy (OR = 1.61, P = .03).

The investigators concluded, “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.”

Kathryn J. Ruddy, MD, MPH, of the Mayo Clinic, is the corresponding author for the Journal of Clinical Oncology article.

The study was supported by a grant from Susan G. Komen for the Cure. The study authors reported no potential conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.