The Supreme Court of the United States (SCOTUS) ruling in Dobbs v Jackson overruled Roe v Wade, returning an individual’s right to access abortion services to state law. New findings led by researchers at the American Cancer Society published by Jiang et al in The Lancet Oncology showed that more than 32,000 newly diagnosed adolescent and young adult (AYA) patients with cancer may lose or face compromised fertility preservation care each year because of legislation that has been enacted or is expected to be enacted in some states. The SCOTUS ruling could potentially interfere with fertility preservation as a result of new restrictions on genetic testing, storage, and disposal of embryos—including those created in vitro. According to the study authors, fertility preservation care will be needed for more than two-thirds of newly diagnosed AYA patients with cancer.

“Accurate information about the adverse consequences of reproductive legislation on access to fertility preservation care for AYA patients with cancer needs to be fully understood by policymakers,” said senior study author Xuesong Han, PhD, epidemiologist, senior principal scientist, and health services researcher in the Department of Surveillance & Health Equity Science at the American Cancer Society. “The data in this study show AYA patients with cancer may be deprived of their ability to preserve their fertility before they start their cancer treatments as a result of new barriers to accessing these critical reproductive services.” 

Study Findings

From the recent national U.S. population-based cancer registry data, researchers identified individuals aged 15 to 44 years old who were newly diagnosed with cancer. Patients requiring fertility preservation as part of cancer care include those diagnosed with any lymphoma, leukemia, bone/joint/soft-tissue sarcoma, testicular cancer, female breast cancer, ovarian cancer, uterine cancer, or cervical cancer, as well as any regional/distant cancer, as patients commonly receive chemotherapy, radiation, or other gonadotoxic treatments. Patients needing fertility care from 22 states where abortion is banned or likely to be banned as of August 6, 2022, were compared with patients from 29 states where abortion remains legal.

According to researchers, among 123,591 newly diagnosed AYA patients in 2018, 85,085 patients (68.8%) would need fertility preservation care—including 32,008 patients from the 22 states where abortion restrictions could compromise fertility preservation care. Among these patients, the majority were female (65.1%) and non-Hispanic White (62.7%). Texas (24.4%), Ohio (9.4%), and Georgia (9.1%) were the states with the largest numbers of newly diagnosed AYA patients with cancer whose fertility preservation care could be compromised. Compared to patients from the 29 states where abortion remains legal, patients from the 22 states with abortion restrictions were more likely to be living in nonmetropolitan areas (18.9% vs 8.2%), the poorest counties (14.6% vs 8.6%), and diagnosed with ovarian, uterine, or cervical cancers (14.2% vs 11.8%).

“These potential fertility preservation restrictions may create barriers for patients and could widen geographical and socioeconomic disparities in the receipt of fertility care,” said lead study author Changchuan Jiang, MD, a third-year medical oncology fellow in the Department of Medicine at Roswell Park Comprehensive Cancer Center. “Ongoing monitoring of the health effects of the Supreme Court decision on patients with cancer and their families is warranted.”  

Disclosure: For full disclosures of the study authors, visit thelancet.com.