Concerns about fertility affect treatment decisions in one-third of young breast cancer patients

Study highlights need for better patient-physician communication about fertility

A new study shows that concern about infertility resulting from breast cancer therapy influenced treatment decisions in nearly one-third of young patients. The study – the largest to date to examine fertility concerns among young women with breast cancer – found that the majority of the women were very concerned about the ability to have a child as well as the impact that pregnancy might have on disease recurrence, despite the relative lack of data on these risks. The study will be published in the October 15 issue of the Journal of Clinical Oncology.

“These findings indicate that women may overestimate infertility risk, and highlight the need for enhanced communication between physicians and patients,” said Ann H. Partridge, MD, MPH, Medical Oncologist at Dana-Farber Cancer Institute, Instructor in Medicine at Harvard Medical School, and lead author of the study. “A key challenge in discussing these issues is the lack of comprehensive data on how cancer therapy affects fertility, particularly when considering newer chemotherapy regimens, and whether getting pregnant after therapy affects the risk of disease recurrence.”

Over 11,500 women under the age of 40 are diagnosed with breast cancer each year in the United States. Some breast cancer therapies may cause women to stop menstruating, either temporarily or permanently, and women who continue to have normal menstrual cycles may go through menopause earlier or may be less fertile following chemotherapy than their peers. In addition, while standard hormone-based cancer therapies do not typically cause permanent infertility, they often require years of treatment during which women are advised not to become pregnant.

Researchers surveyed 657 members of the Young Survival Coalition (YSC), a breast cancer patient advocacy group, on their attitudes about fertility. Members were required to be premenopausal and age 40 years or younger at the time of breast cancer diagnosis.

Fifty-seven percent of patients reported being very concerned about becoming infertile, regardless of their age or stage of disease, and 29% said concern about infertility influenced their decisions about treatment. Seventy-two percent discussed fertility issues with their doctors, and 17% discussed these issues with fertility specialists. While 51% of women felt satisfied after discussing the issue with their doctors, 26% felt that their fertility concerns had not been adequately addressed.

The researchers highlighted the need for more data on the impact of treatment on fertility, as well as the development of new approaches to preserving fertility in women treated for breast cancer.

“Young cancer patients have very few options for preserving their fertility, which further complicates treatment decisions,” said Dr. Partridge. “Additional research in these areas will help physicians and patients select treatments that are optimized to meet both medical and future fertility goals.”