Prevalence and impact of fertility concerns in young women with breast cancer

Abstract

Survey data from the Mayo Clinic Breast Disease Registry were used to assess fertility counseling and fertility preservation strategies in a modern cohort of young women with breast cancer. One hundred respondents were identified who were under age 50 at the time of breast cancer diagnosis and who expressed interest in future childbearing near the time of diagnosis and/or 1 year later. Ninety-three percent of the 81 respondents to the year one survey recalled fertility counseling prior to cancer treatment. Most who reported a high level of fertility concern declared that this concern had impacted their treatment decisions, often shortening their planned duration of endocrine therapy. Approximately half had taken steps to preserve future fertility, and a third had used a gonadotropin-releasing hormone agonist either alone or combined with another method (e.g., embryo or oocyte cryopreservation).

Figure 1

Participant selection. A participant was considered to have indicated interest if they answered, ‘yes’ or ‘unsure’ to the question: ‘At the present time, do you wish to have any/any more biological children in the future?’ *Of these 10, six selected ‘yes/unsure’ on the Y1 and ‘no’ on the baseline, and four selected ‘yes/unsure’ on the Y1 and left this question blank on the baseline.

Figure 2

Degree of fertility concern and impact on treatment decision, year 1. The graph on the left demonstrates the degree of fertility concern recalled by respondents at the time of treatment decisions, as reported on the Y1 survey. The graph on the right shows data from a subset of respondents to display impact of fertility concern on treatment decision among those women who recalled that they were “very concerned”.

Figure 3

Treatment changes made in response to fertility concerns, year 1 (n = 22). Includes respondents who chose an answer to the question ‘Have fertility concerns affected your treatment decisions in any of the following ways?’ other than ‘no effect’ or ‘none of the above’ on the Y1 survey. Some respondents selected more than one answer. ‘Less endocrine therapy’ includes respondents who had chosen or may choose to take tamoxifen or other hormonal medication for less than 5 years. ‘No endocrine therapy’ includes respondents who had chosen not to take tamoxifen or other hormonal medication (including ovarian suppression medication) even though it was offered.

Figure 4

Methods of fertility preservation used (n = 39). Includes respondents who answered, ‘yes’ to the question ‘Before you began therapy or during therapy, did you take any special steps to lower the chance that you would become infertile with cancer treatment?’ on the Y1 survey. Some respondents selected more than one answer.