Disparities observed in oncofertility among women with breast, gynecologic cancers
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Women diagnosed with breast or gynecologic cancers underutilized both assisted reproductive technology and fertility-sparing oncology care, according to study results.
The findings, presented during the Society of Gynecologic Oncology 2022 Annual Meeting on Women’s Cancer, additionally showed that women residing in urban vs. rural areas and those with private insurance vs. Medicaid used assisted reproductive technology and fertility-sparing oncology care more frequently, regardless of cancer type.
Rationale and methods
Two beneficial approaches to preserve fertility are available for women diagnosed with breast or gynecologic cancers, including assisted reproductive technology — medical treatments or procedures that handle eggs and sperm to address infertility — and fertility-sparing oncology care — surgical or medical interventions that retain the uterus and at least one ovary for gynecologic cancers, according to study background.
However, research is limited on the association between sociodemographic characteristics and the use of assisted reproductive technology or receipt of fertility-sparing oncology care among women with a history of gynecologic or breast cancers, Kirsten Jorgensen, MD, a fellow in the department of gynecologic oncology at The University of Texas MD Anderson Cancer Center, and colleagues wrote.
For this reason, researchers pooled data from the California Cancer Registry database to examine rates of assisted reproductive technology use or receipt of fertility-sparing oncology care among 44,529 women aged 18 to 45 years diagnosed with stage I to stage III breast cancer, stage IA or stage IC ovarian cancer, stage IA or stage IB cervical cancer, or stage IA or stage IB endometrial cancer between 2004 and 2015.
Researchers stratified results by race, geography and insurance type. They used chi-square tests and logistic regressions to compare outcomes.
The use of assisted reproductive technology served as the primary outcome, and receipt of fertility-sparing oncology care after a gynecologic cancer diagnosis served as a secondary outcome.
Key findings
Overall, 236 women (0.5%) utilized assisted reproductive technology. Among them, Black (OR = 0.32; 95% CI, 0.14-0.73) and Hispanic women (OR = 0.3; 95% CI, 0.19-0.49) with a history of breast cancer less frequently received assisted reproductive technology than white women. Hispanic women with a history of cervical cancer also received assisted reproductive technology less frequently than white women (OR = 0.33; 95% CI, 0.11-0.98).
Women with a history of breast cancer used assisted reproductive technology less frequently if they lived in rural areas vs. urban areas (OR = 0.13; 95% CI, 0.04-0.39), as did recipients of Medicaid vs. private insurance (OR = 0.28; 95% CI, 0.14-0.56).
Researchers additionally found that 1,814 (22.5%) of the 8,061 women with a gynecologic malignancy received fertility-sparing oncology care. Among them, Black (OR = 1.77; 95% CI, 1.15-2.73) and Hispanic (OR = 1.48; 95% CI, 1.19-1.84) women diagnosed with ovarian cancer had a higher likelihood of receiving fertility-sparing oncology care compared with white women. Black (OR = 2.62; 95% CI, 1.01-6.73) and Asian/Pacific Islander women (OR = 2.83; 95% CI, 1.65-4.86) diagnosed with endometrial cancer also had a higher likelihood of receiving fertility-sparing oncology care than white women.
Compared with women living in urban areas, those living in rural areas had a lower likelihood of receiving fertility-sparing oncology care for cervical (OR = 0.76; 95% CI, 0.6-0.96) and ovarian cancers (OR = 0.54; 95% CI, 0.36-0.75).
Implications
Further research is needed to better understand the differences observed in this study population, given overall infrequent outcomes, Jorgensen and colleagues wrote.
References:
Jorgensen K, et al. Abstract 94. Presented at: Society of Gynecologic Oncology 2022 Annual Meeting on Women’s Cancer (hybrid meeting); March 18-21, 2022; Phoenix.
MD Anderson research highlights: SGO 2022 special edition. Available at: www.mdanderson.org/newsroom/md-anderson-research-highlights--sgo-2022-special-edition.h00-159538167.html. Published March 21, 2022. Accessed March 23, 2022.
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Jorgensen K, et al. Abstract 94. Presented at: Society of Gynecologic Oncology 2022 Annual Meeting on Women’s Cancer (hybrid meeting); March 18-21, 2022; Phoenix.
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