Fertility preservation not associated with risk for breast cancer recurrence
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Fertility preservation did not appear associated with an increased risk for breast cancer recurrence or disease-specific mortality among a cohort of young women diagnosed with breast cancer, according to study results.
The findings, published in JAMA Oncology, suggest fertility preservation is safe and relevant for reproductive counseling of women with breast cancer diagnosed during childbearing years, researchers noted.
Methods
“It is not unusual that women with hormone-positive breast cancer or their treating doctors opt out of the procedures for fertility preservation because of the fear that these procedures will increase the risk [for] cancer recurrence or death,” Anna Marklund, a PhD student in the oncology-pathology department at Karolinska Institute in Stockholm, said in a press release. “In some cases, women are also advised to wait 5 to 10 years before trying to conceive, and with increasing age, fecundity in all women decreases. More knowledge is therefore needed about the safety of procedures for fertility preservation at the time of a breast cancer diagnosis.”
Marklund and colleagues conducted the Swedish nationwide prospective cohort study to examine the risk for disease-specific mortality and relapse among 1,275 women with breast cancer (mean age at diagnosis, 32.9 years) who underwent fertility preservation (n = 425) with or without hormonal stimulation compared with women who did not undergo fertility preservation (n = 850) at the time of breast cancer diagnosis between Jan. 1, 1994, and June 30, 2017.
Researchers assessed RFS among a subcohort of 241 women who underwent fertility preservation compared with 482 women who did not. They matched the women for age at diagnosis, calendar period at diagnosis and health care region. Researchers additionally pooled data from nationwide health care registers and population registers with data on outcomes, disease- and treatment-related variables, and socioeconomic characteristics.
Relapse and disease-specific mortality after breast cancer diagnosis served as main outcomes.
Findings
Results showed similar disease-specific mortality among women who underwent hormonal fertility preservation (adjusted HR = 0.59; 95% CI, 0.32-1.09), those who underwent nonhormonal fertility preservation (adjusted HR = 0.51; 95% CI, 0.2-1.29) and those who did not undergo fertility preservation.
Moreover, researchers reported 5-year breast cancer-specific survival rates of 96% among women who underwent hormonal fertility preservation, 93% among those who underwent nonhormonal fertility preservation and 90% among women who did not undergo fertility preservation, and corresponding 10-year rates of 88%, 90% and 81%.
Researchers also reported similar 5-year RFS rates among the groups, including 89% among women who underwent hormonal fertility preservation, 83% among those who underwent nonhormonal fertility preservation and 82% among women who did not undergo fertility preservation. Estimates after 10 years were 82%, 80% and 73% among the three groups.
In a subcohort of women with detailed data on relapse who underwent RFS assessment, researchers also found no statistically significant difference in the adjusted rate of disease-specific mortality and relapse among those who underwent hormonal fertility preservation (adjusted HR = 0.81; 95% CI, 0.49-1.37) compared with those who underwent nonhormonal fertility preservation (adjusted HR = 0.75; 95% CI, 0.35-1.62).
Looking ahead
Researchers plan to follow-up on the study findings after another 5 years, according to the press release.
“We did not see any increased risk for relapse or mortality when procedures for fertility preservation were undertaken compared [with] women who did not undergo procedures for fertility preservation,” Kenny A. Rodriguez-Wallberg, MD, PhD, adjunct professor and researcher in the oncology-pathology department at Karolinska Institute and chief physician at Karolinska University Hospital, said in the press release. “This is valuable information that can contribute to changed care routines when it comes to young women with breast cancer who want to preserve their fertility.”
References
- Fertility preservation measures do not appear to increase the risk of breast cancer recurrence (press release). Available at: www.sciencedaily.com/releases/2022/08/220825115826.htm. Published Aug. 25, 2022. Accessed Oct. 4, 2022.
- Marklund A, et al. JAMA Oncol. 2022;doi:10.1001/jamaoncol.2022.3677.
Perspective
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Erin Roesch, MD
Breast cancer among young women is associated with unique challenges related to their stage of life, including education and career development, family planning and fertility. Compared with older women, young women tend to be diagnosed with breast cancer at more advanced stages and characterized by more aggressive biological features. Therefore, treatment protocols often include chemotherapy, which can impact fertility. Further, many young women will be recommended endocrine therapy for 5 to 10 years, and this can present a potential obstacle to future childbearing.Prompt discussion regarding the possible effects of cancer treatment on fertility is essential, and women who are interested in learning more about or pursuing fertility preservation should be referred to a reproductive specialist. Both patients and providers may express concerns about delay in time to treatment and/or use of hormonal therapy as a component of fertility preservation techniques. This study contributes to the existing body of literature regarding the safety of fertility preservation for young women diagnosed with breast cancer. Survival outcomes overall were excellent and similar for those who pursued hormonal fertility preservation, nonhormonal fertility preservation and those unexposed to fertility preservation.
Oncofertility is an integral component of the care provided to young women diagnosed with breast cancer. It is reassuring to have these data to share with patients to help ensure they are fully informed as they make decisions surrounding fertility preservation. Upon diagnosis of breast cancer, the focus is correctly on timely initiation of optimal treatment; however, it is also vital to address future family planning goals for young women. These data provide further support that pursuit of fertility preservation and maintaining high breast cancer survival rates can both be achieved. Longer-term follow-up will be important to gain additional insight on fertility preservation safety and outcomes for these young women.
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