Fertility concerns may impact treatment decisions for young women with breast cancer

Key takeaways:

• One-third of women reported concerns regarding fertility that affected their treatment decisions.
• One-fifth of women who discussed concerns with physicians used fertility preservation strategies.

Many young women with newly diagnosed breast cancer have concerns regarding fertility, and these concerns may impact their treatment decisions, according to study findings published in Cancer Medicine.

“As postponement of pregnancy to the 30s and 40s is becoming more common in the general population, it is more likely that a young woman who is diagnosed with breast cancer may not have started or completed her family and may harbor concerns about treatment-related infertility,” Elisabeth de Kermadec, MD, MPH, clinical researcher in medical oncology at the Dana-Farber Cancer Institute and the breast oncology program at the Dana-Farber Brigham Cancer Center, Boston, and colleagues wrote. “Attention to this issue for all adolescent and young adult cancer patients is now recommended by international guidelines, and recent studies suggest that there is still suboptimal attention to fertility.”

De Kermadec and colleagues conducted the Young and Strong study, a large, prospective, geographically and racially/ethnically diverse cluster-randomized controlled trial with data from 467 women with breast cancer (median age, 40 years) from 54 U.S. clinical sites. Researchers tested an intervention program surveying participants at 3, 6 and 12 months following their diagnosis to assess fertility concerns and efforts in fertility preservation. The surveys included questions on sociodemographics, psychosocial domains, fertility concerns and fertility preservation strategies.

Of the participants, 419 were evaluable regarding fertility concerns. Of these, 11% were Black and 6% were Hispanic; 75% already had children. Overall, 35% of the women had stage I breast cancer, 51% had stage II and 14% had stage III, and 82% of the women received chemotherapy.

During the treatment decision period, 32% of women reported concerns regarding fertility. Of these women, 47% noted that these concerns impacted their treatment decisions. Discussions with physicians regarding fertility occurred among 60% of women, with 20% of these women utilizing fertility preservation strategies.

In addition, in multivariable models, researchers observed an association with higher odds of fertility concerns among women with a history of conception difficulties and younger age.

“As a significant proportion of women are concerned about fertility at diagnosis that may impact their treatment decisions, it is critical to ensure that these issues are adequately addressed,” the researchers wrote.