Research examining fertility preservation and pregnancy attempts among young women following a breast cancer diagnosis has been hampered by short-term follow-up and a lack of prospective assessment of pregnancy attempts. A new long-term study investigating fertility outcomes among young women who reported attempting pregnancy following a breast cancer diagnosis has found that the majority of women were able to achieve a pregnancy and most reported experiencing a live birth. The study by Sorouri et al will be presented during the 2024 ASCO Annual Meeting (Abstract 1518).

Study Methodology

The researchers analyzed data from women with stage 0 to III breast cancer participating in the Young Women's Breast Cancer Study (ClinicalTrials.gov identifier NCT01468246), a multicenter, prospective cohort trial of women diagnosed with breast cancer at age 40 and younger from 2006 to 2016 who reported attempting pregnancy postdiagnosis. Patients who had a prior hysterectomy, bilateral oophorectomy, or metastatic disease at diagnosis were excluded from the analysis.

Data on attempting pregnancy and fertility outcomes were obtained from serial surveys. Multivariable logistic regression with stepwise model selection was used to identify factors associated with pregnancy and live birth. 

Results

The study results show that among 1,213 eligible participants, 197 reported any attempt of pregnancy (16%) over a median follow-up of 11 years (range = 3–17). Among women who attempted pregnancy, median age at diagnosis was 32 years (range = 17–40); 74% were non-Hispanic White; 41% had stage I disease, 35%, stage II, 10%, stage III, and 14% stage 0 breast cancer. Among the participants, 76% had hormone receptor–positive disease; 68% received chemotherapy; 57% received endocrine therapy within 1 year postdiagnosis; 13% were BRCA1/2 pathogenic variant carriers; 51% reported financial comfort at baseline; 51% were nulligravida (never pregnant) and 72% were nulliparous (no live births) at diagnosis; 28% had undergone fertility preservation consisting of egg/embryo freezing at diagnosis; and 15% reported a history of infertility before their breast cancer diagnosis.

Most participants (73%) reported at least one pregnancy after diagnosis and 65% reported at least one live birth. Median time from diagnosis to first pregnancy was 48 months (range = 6–125).

In the multivariable model, greater age at diagnosis (odds ratio [OR] = 0.82 per year increase, 95% confidence interval [CI] = 0.74–0.90, P < .0001) was negatively associated with pregnancy, while financial comfort at baseline (OR = 2.04, 95% CI = 1.01–4.12, P = .047) was predictive of pregnancy.

The study found that older age at diagnosis was negatively associated with likelihood of live birth (OR = 0.82 per year increase, 95% CI = 0.76–0.90, P < .0001), while having undergone fertility preservation at diagnosis was predictive of a live birth (OR = 2.78, 95% CI = 1.29–6.00, P = .009). History of infertility, nulliparity at diagnosis, tumor characteristics, cancer treatment, race, ethnicity, and BRCA1/2 pathogenic variant status were not associated with either outcome. 

Conclusions

This prospective study with more than 10 years of follow-up found that the majority of young breast cancer survivors achieved a pregnancy and most reported a live birth. These findings can be incorporated into the counseling of young breast cancer survivors, and highlight the need for accessibility to fertility preservation services for this population, concluded the study authors. 

Disclosure: Funding for this study was provided by Susan G. Komen and the Breast Cancer Research Foundation. For full disclosures of the study authors, visit coi.asco.org.