Fertility preservation leads to breast cancer treatment delays but not shorter survival
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Fertility preservation after breast cancer diagnosis led to short delays in time to treatment, according to results of a retrospective cohort study published in Cancer.
However, the delays did not negatively affect survival outcomes.
“Fertility is of particular concern among young breast cancer survivors, prompting a growing need to understand the implications of completing a fertility preservation cycle prior to initiation of cancer treatment,” Anna C. Vanderhoff, MD, researcher in the department of obstetrics, gynecology and reproductive biology at Brigham and Women’s Hospital, told Healio. “This goal of this research was to be able to provide clinicians and patients with evidence-based answers regarding the impact of fertility preservation on timing of treatment and breast cancer outcomes.”
Vanderhoff and colleagues examined the safety of ovarian stimulation for fertility preservation among 272 women aged 20 to 45 years with newly diagnosed stage zero to stage III breast cancer. All women participated in a fertility preservation consultation between 2005 and 2017, and 123 (45.2%) went on to undergo the process.
Women who underwent fertility preservation appeared more likely than those who did not undergo fertility preservation to be white (87.8% vs. 67.8%; P = .002) and have BRCA-positive disease (27.7% vs. 15.5%; P = .021).
Median follow-up was approximately 4 years.
Results showed women who underwent fertility preservation experienced longer time to first treatment (37 days vs. 31 days; adjusted HR [aHR] = 0.74; 95% CI, 0.56-0.99) and longer time to neoadjuvant chemotherapy (36 days vs. 26 days; aHR = 0.41; 95% CI, 0.24-0.68). They also experienced longer time from surgery to adjuvant therapy (41 days vs. 33 days; aHR = 0.58; 95% CI, 0.38-0.9).
However, the groups had comparable 3-year (85.4% vs. 79.4%) and 5-year (73.7% vs. 67.1%) adjusted invasive DFS rates. Moreover, researchers observed no differences between the fertility preservation and nonpreservation groups in 3-year OS (95.5% vs. 93.5%) or 5-year OS (84.2% vs. 81.4%).
“This study provides new evidence on the specific breast cancer treatment delays associated with fertility preservation,” Vanderhoff told Healio. “We demonstrated delays in time to first treatment and time to neoadjuvant chemotherapy. It also bolsters the findings from prior research that suggest no impact of fertility preservation on breast cancer recurrence and mortality.
“We will continue research in this area to provide high-quality data when discussing the pros and cons of fertility preservation with our patients. We hope to examine the impact of fertility preservation on specific breast cancer subtypes and other forms of malignancy,” she added.
For more information:
Anna C. Vanderhoff, MD, can be reached at Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115; email: acvanderhoff@partners.org.
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