In 2023, nearly 300,000 new cases of invasive breast cancer were diagnosed in the United States, and approximately 56,000 new cases of ductal carcinoma in situ were diagnosed. Although most of those cancers are diagnosed in older adults, about 9% of all new cases of breast cancer are found in women aged 45 and younger, according to the Centers for Disease Control and Prevention. Tumors in this patient population are more likely to be aggressive, requiring intensive therapies, including multiagent chemotherapy that impacts fertility.

A large prospective study by researchers at Dana-Farber Cancer Institute investigating concerns about fertility and efforts to preserve fertility after a breast cancer diagnosis in young women has found that although many newly diagnosed patients are concerned about fertility and discussed their concerns with their oncologists, few pursued fertility preservation. The findings suggest that patients might face barriers to oncofertility care, including financial or geographic access, lack of referral, or uncertainty. They also have implications for counseling young patients, according to the study authors. The study by de Kermadec et al was published in Cancer Medicine.

Study Methodology

The researchers analyzed data from Young and Strong: An Education and Supportive Care Intervention Study for Young Women With Breast Cancer (Y&S), a cluster-randomized controlled trial testing an intervention program for young women with breast cancer. Between 2012 and 2013, patients were surveyed within 3 months after their diagnosis and at 3, 6, and 12 months after their diagnosis. Survey questions asked about sociodemographics, psychosocial domains, fertility concerns, and fertility preservation strategies.

Of 467 women from 54 clinical sites across the United States, 419 were evaluable regarding fertility concerns. The median age was 40 years (range = 22–45), 11% were Black, 6% were Hispanic, and 75% had children. Cancer stage was I (35%), II (51%), or III (14%); and 82% of the patients had received chemotherapy.

Univariable and multivariable models were used to investigate sociodemographic, clinical, and psychosocial predictors of fertility concerns.

Results

At the time of the treatment decision, 133 (32%) of the study participants had fertility concerns, among whom 47% indicated this affected their treatment decisions. Sixty percent of participants reported having discussed fertility with their physician. Despite guidelines recommending that health-care providers refer patients who express interest in fertility preservation to reproductive specialists, only 22% of those with fertility concerns used fertility preservation strategies. A history of difficulty becoming pregnant and younger age were associated with higher odds of fertility concerns in multivariable modeling.

“Many young women with newly diagnosed breast cancer are concerned about fertility in a way that impacts their treatment decisions. Concerns were discussed, but few used fertility preservation strategies. These findings have implications for counseling young patients,” concluded the study authors.

Ann H. Partridge, MD, MPH, of Dana-Farber Cancer Institute, is the corresponding author of this study.

Disclosure: Funding for this study was provided by Conquer Cancer, the ASCO Foundation; Susan G. Komen, Breast Cancer Research Foundation; and the National Institutes of Health. For full disclosures of the study authors, visit onlinelibrary.wiley.com.