ASBS 2016: Fertility Counseling in Women of Childbearing Age After Breast Cancer
Despite recent advances in assisted reproductive technology for women with breast cancer, documented fertility counseling at diagnosis remains low, while 89% of those made aware of their options sought specialized consultation for reproductive preservation. Almost 50% of these women chose one of the options discussed. These were the findings of a new study presented April 16 at the American Society of Breast Surgeons Annual Meeting in Dallas.
“This study shows that whether or not they eventually attempt to become pregnant, most women want to maintain the option,” said primary study author Devina McCray, MD, Breast Surgical Oncology Fellow at the Cleveland Clinic. She noted that cancer treatments such as chemotherapy may damage or destroy egg cells, leaving a woman unable to bear children after cancer therapy.
Today, a range of new and increasingly effective avenues are available to help women start a family following breast cancer treatment. However, these methods typically involve decisions made in advance of therapy, with limited options once treatment is underway.
“This study suggests that women concerned with future child-bearing should actively seek out assisted reproduction counseling before treatment, and health-care professionals involved with these patients should provide information and education,” said Dr. McCray.
Study Findings
The retrospective study reviewed all women aged 40 and younger treated for breast cancer with chemotherapy and/or antihormonal therapy at Cleveland Clinic from 2006 to 2014. It involved 303 qualifying patients with an average age of 35.7 years and a median follow-up of 3.7 years. At diagnosis, 32% were single, 68% were married, and 27% had no children.
Eighty patients (26%) had a documented fertility discussion. Of these, only nine (11%) did not pursue in vitro fertilization consultation or gonadotropin-releasing hormone (GnRH) agonists for ovarian protection during chemotherapy.
According to Dr. McCray, in vitro fertilization is a common technique used to retain the option to bear children for women undergoing treatment of breast cancer. Healthy eggs are harvested prior to treatment, fertilized externally, and when pregnancy is desired, implanted into the uterus. In addition, increasingly, GnRH agonists are used to provide ovarian protection during chemotherapy. Targeting highly active cells, chemotherapy typically affects both cancer and ovarian cells, which often decreases future ovarian function.
Of the 303 women studied, 22 (7%) became pregnant within the median 3.7-year follow-up period. Fifty-five patients (69%) received counseling about in vitro fertilization procedures, and 17 (31%) pursued this option. Of these, four (24%) eventually became pregnant, as did five patients treated with GnRH agonists. Ten patients not pursuing in vitro fertilization consultation or GnRH agonist therapy became pregnant spontaneously. Overall, successful pregnancy was associated with younger age at the time of diagnosis and estrogen receptor–negative and progesterone receptor–negative tumors.
Timely Counseling Important
Dr. McCray reported that the most frequent form of cancer among women of reproductive age is breast cancer, according to the National Cancer Institute. Statistics from the American Cancer Society reveal that approximately 12,500 women under age 40 are diagnosed with breast cancer in the United States annually. However, few studies have examined the frequency of fertility preservation counseling in breast cancer patients in particular.
“With advancing techniques to maintain childbearing after breast cancer, a growing number of patients can look forward to raising a family in the future,” said Dr. McCray. “Timely counseling is extremely important so women are able to take full advantage of their options.”
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
