Prospective Study of Fertility Concerns and Preservation Strategies in Young Women With Breast Cancer

TLDR

Most research on fertility in young breast‑cancer patients has focused on long‑term survivors, leaving a gap in understanding how early fertility concerns influence treatment decisions and preservation strategies. The study prospectively surveyed 620 newly diagnosed breast‑cancer patients aged ≤40 across multiple centers, collecting sociodemographic, medical, and treatment data plus a modified Fertility Issues Survey, and used univariable and multivariable models to identify predictors of heightened fertility concern. Among 620 women, 68 % discussed fertility with physicians and 51 % were concerned, and such concerns led 1 % to forgo chemotherapy, 2 % to alter regimens, 3 % to forgo endocrine therapy, 11 % to shorten it, while only 10 % pursued preservation; younger age, non‑white race, nulliparity, and chemotherapy were associated with greater concern.

Abstract

Most research regarding fertility in young women with breast cancer has focused on long-term survivors. Little is known about how fertility concerns affect treatment decisions or fertility preservation strategies at the time of initial cancer diagnosis.As part of an ongoing prospective multicenter cohort study, we surveyed women with newly diagnosed early-stage breast cancer at age ≤ 40 years. The baseline survey included sociodemographic, medical, and treatment data as well as a modified Fertility Issues Survey, including fertility concern and preservation items. Univariable and multivariable modeling were used to investigate predictors of greater fertility concern.Among the first 620 eligible respondents included in this analysis, median age was 37 years (range, 17 to 40 years); 425 women (68%) discussed fertility issues with their physicians before starting therapy, and 319 (51%) were concerned about becoming infertile after treatment. Because of concerns about fertility, four women (1%) chose not to receive chemotherapy, 12 (2%) chose one chemotherapy regimen over another, six (1%) considered not receiving endocrine therapy, 19 (3%) decided not to receive endocrine therapy, and 71 (11%) considered receiving endocrine therapy for < 5 years; 65 (10%) used fertility preservation strategies. Greater concern about fertility was associated with younger age, nonwhite race, not having children, and receipt of chemotherapy.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.