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Fertility Preservation Procedures at Breast Cancer Diagnosis: Risk of Relapse and Disease-Specific Mortality


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In a Swedish nationwide prospective cohort study reported in JAMA Oncology, Marklund et al found no increased risk of relapse or disease-specific mortality among women undergoing fertility preservation with or without hormonal stimulation at time of breast cancer diagnosis.

Study Details

The study identified women undergoing fertility preservation from regional programs at Swedish university hospitals between January 1994 and June 2017. A total of 425 women who underwent fertility preservation were matched for age, calendar period of diagnosis, and region with 850 population comparators from regional breast cancer registers.  Among the 425 women who underwent fertility preservation, 367 had hormonal and 58 had nonhormonal procedures. After stratification for the matching variables, analyses were adjusted for country of birth, education, parity at diagnosis, tumor size, number of lymph node metastases, and estrogen receptor status.   

Key Findings 

Median follow-up was 4.0 years among women who underwent hormonal fertility preservation, 3.8 years in their matched controls, and 6.7 years in both women who underwent nonhormonal fertility preservation and their matched controls.

In this cohort study, fertility preservation with or without hormonal stimulation was not associated with any increased risk of relapse or disease-specific mortality in women with breast cancer.
— Marklund et al

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Compared with controls who did not undergo fertility preservation, adjusted hazard ratios (HRs) for disease-specific mortality were 0.59 (95% confidence interval [CI] = 0.32–1.09) among women who underwent hormonal fertility preservation and 0.51 (95% CI = 0.20–1.29) among those who underwent nonhormonal fertility preservation. Disease-specific survival rates at 5 and 10 years were 96% and 88% among women undergoing hormonal fertility preservation, 93% and 90% among those undergoing nonhormonal fertility preservation, and 90% and 81% in controls.

A subgroup of 723 women, including 198 who underwent hormonal fertility preservation, 43 who underwent nonhormonal fertility preservation, and 482 matched controls, had full information on relapse. In this population, compared with controls, adjusted hazard ratios for risk of relapse or disease-specific mortality were 0.81 (95% CI = 0.49–1.37) among those who underwent hormonal fertility preservation and 0.75 (95% CI = 0.35–1.62) among those who underwent nonhormonal fertility preservation. Relapse-free survival rates at 5 and 10 years were 89% and 82% among those undergoing hormonal fertility preservation, 83% and 80% among those undergoing nonhormonal fertility preservation, and 82% and 73% in the control group.

The investigators concluded, “In this cohort study, fertility preservation with or without hormonal stimulation was not associated with any increased risk of relapse or disease-specific mortality in women with breast cancer. Results of this study provide much-needed additional evidence on the safety of fertility preservation procedures in women with breast cancer and may influence current health-care practice to the benefit of young women with breast cancer who wish to preserve their fertility.”

Kenny A. Rodriguez-Wallberg, MD, PhD, of the Department of Reproductive Medicine, Karolinska University Hospital Huddinge, Stockholm, is the corresponding author for the JAMA Oncology article.

Disclosure: The study was supported by the Swedish Cancer Society, Cancer Research Funds of Radiumhemmet, Swedish Breast Cancer Association, and others. For full disclosures of the study authors, visit jamanetwork.com.

 

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®.
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