Estimates of young breast cancer survivors at risk for infertility in the U.S

Abstract

Background: Standard treatments for breast cancer can impair fertility. It is unknown how many U.S. survivors are at risk for infertility. We estimated the population at risk for infertility secondary to treatment among reproductive-aged breast cancer survivors.

Methods: We combined data from three sources: the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results cancer registry data on incident breast cancers diagnosed in women aged 15-44 years between 2004 and 2006; treatment data from NPCR's 2004 Breast and Prostate Cancer Data Quality and Patterns of Care (PoC) study; and data on women's intentions to have children from the 2006-2010 National Survey of Family Growth (NSFG).

Results: In the cancer registry data, an average of 20,308 women with breast cancer aged <45 years were diagnosed annually. Based on estimates from PoC data, almost all of these survivors (97%, 19,416 women) were hormone receptor positive or received chemotherapy and would be at risk for infertility. These women need information about the impact of treatments on fertility. Estimates based on NSFG data suggest approximately half of these survivors (9,569 women) might want children and could benefit from fertility counseling and fertility preservation.

Conclusion: Nearly all young breast cancer survivors in the U.S. are at risk for infertility. Physicians should discuss the potential impact of treatment on fertility. A smaller but sizeable number of at-risk survivors may be interested in having children. Given the magnitude of potential infertility and its quality-of-life implications, these survivors should have access to and potential coverage for fertility services.

Keywords: Breast neoplasms; Fertility preservation; Infertility; Pregnancy; Reproductive behavior; Survivors.

Figure 1.

Analytic method using prediction of hormone receptor status as an example. Abbreviations: NPCR, National Program for Cancer Registries; NSFG, National Survey of Family Growth; PoC, Breast and Prostate Cancer Data Quality and Patterns of Care; SEER, Surveillance, Epidemiology, and End Results.

Figure 2.

Annual estimates of the number of young women diagnosed with breast cancer (from the National Program for Cancer Registries and Surveillance, Epidemiology, and End Results cancer database), the numbers with estrogen receptor-positive or progesterone receptor-positive tumors or who received chemotherapy (from the Centers for Disease Control and Prevention’s Breast and Prostate Cancer Data Quality and Patterns of Care study) and who may intend to have children (from the National Survey of Family Growth).