Determinants of access to fertility preservation in women with breast cancer

Abstract

Objective: To evaluate socioeconomic, demographic, and medical factors that influence the referral pattern-either before cancer treatment for fertility preservation (FP, early referral) or post-chemotherapy for assisted reproductive technology (PCART, delayed referral)-in women with breast cancer.

Design: Secondary analysis.

Setting: Academic medical centers.

Patient(s): Three hundred fourteen patients with breast cancer who were counseled for FP (n=218) or PCART (n=96) from June 1999 to July 2009.

Intervention(s): None.

Main outcome measure(s): Factors favoring early referrals.

Result(s): Mean age at diagnosis was higher in FP vs. PCART (35.3±4.5 years vs. 33.9±4.7 years). Ninety percent presented with cancer stage 1 or 2. From 2000 to 2009 the proportion of referrals for FP increased continually. In 2009, nearly all (95.5%) were for FP. The majority (63.8%) was referred from an academic center. Patients with a family history of breast cancer were more likely to consult for FP (75.2% vs. 64.3% without). There was no association with occupation, income, race, ethnicity, obstetric history, and prior infertility treatment. Only 22.9% of those counseled in PCART, compared with 45.0% in the FP group, proceeded with a procedure.

Conclusion(s): There has been an increasing trend within the last 10 years for early referral of breast cancer patients to FP. Factors favoring early referrals are older age, early-stage cancer, family history of breast cancer, and academic center involvement. Those seen before cancer treatment are more likely to receive an intervention.

Figure 1

Flow of study participants

Figure 2

Proportion of referral for FP increased contiually from 2000 to 2009. FP: Fertility preservation (early referral) PCART: Post-chemotherapy assisted reproduction (delayed referral)

Figure 3

Proportion of referral for FP inversely associated with the stage of breast cancer. FP: Fertility preservation (early referral) PCART: Post-chemotherapy assisted reproduction (delayed referral)