Feb 24, 2014
By Shira Klapper, Senior Writer/Editor
A study published in the Journal of Clinical Oncology (JCO) online ahead of print (February 24, 2014), looked at 620 young women recently diagnosed with breast cancer and found that a majority of the patients professed concerns about infertility—but only a small percentage modified their oncologic treatment or pursued fertility preservation strategies.
| Kathryn J. Ruddy,
The multi-site study, “A Prospective Study of Fertility Concerns and Preservation Strategies in Young Women with Breast Cancer,” is one of the largest surveys to look at fertility issues among women recently diagnosed with breast cancer. According to the paper’s first author, Kathryn J. Ruddy, MD, MPH, who performed the study at the Dana-Farber Cancer Institute in collaboration with Dr. Ann Partridge, the current study was designed to address a gap in the research.
“Most previous research in this field has looked at fertility concerns in long-term survivors of breast cancer,” said Dr. Ruddy. “But fertility concerns soon after diagnosis may be the most important. We know that many young survivors are distressed by the reality that breast cancer treatments may have reduced their fertility or made them infertile. What we wanted to learn from this study was how big of an issue these concerns are soon after diagnosis, and how they affect the decisions women are making about their treatments.”
Dr. Ruddy and her colleagues wanted to shed more light on that critical moment of diagnosis, so they identified women 40 years old and younger who had received a breast cancer diagnosis within the last six months. The patients were asked to fill out surveys about their level of fertility concern, their hopes for future childbearing, whether their doctors spoke with them about risks to fertility, and how concerns about fertility affected their decisions regarding treatment—for example, whether they chose not to receive chemotherapy, or whether they were planning to cut short their time on Tamoxifen, a drug usually prescribed for 5-10 years to women with hormonally sensitive tumors, but which is not safe during pregnancy.
The survey findings: While 51% of women reported concern about becoming infertile, only 18% considered modifying their medical treatment to preserve fertility, and only 10% used fertility preservation techniques such as embryo and egg freezing. The study found greater fertility concern among younger women, non-white women, women without children, and women who were receiving chemotherapy.
One possible explanation for the wide margin between the number of women who were concerned about fertility and the number who actually took steps to preserve fertility is the high cost of embryo cryopreservation and oocyte cryopreservation (freezing fertilized and unfertilized eggs, respectively) as insurance coverage varies for procedures.
The wide margin might also be explained by another finding that emerged from this study.
“Nearly a third of participants didn’t recall discussing fertility issues with their doctors before they started therapy,” said Dr. Ruddy, suggesting that doctors might be missing an important window of opportunity.
Dr. Ruddy and her colleagues were surprised that the percentage of patients who recalled that a doctor had discussed treatment-associated risks to fertility with them hadn’t changed since 2006, the year ASCO issued detailed guidelines about the importance of early attention to fertility issues in cancer patients. The guidelines were updated in 2013 (click here for links to guidelines, clinical tools, and educational videos about fertility co-produced by ASCO University and the LIVESTRONG Foundation).
“We were expecting that this percentage would have increased,” said Dr. Ruddy. “It had seemed to us that oncologists were growing more and more cognizant of how crucial it is to counsel cancer patients about fertility, but these data somewhat call that into question.”
While the topic of fertility is important among all cancer types, it might be particularly relevant to breast cancer patients, who usually do not have to start treatment immediately after diagnosis.
“Unlike someone newly diagnosed with, for example, acute leukemia, in whom treatment needs to be started within hours to days, a breast cancer patient can often delay systemic therapy for a few weeks in order to pursue egg freezing without worrying about substantially detrimentally impacting prognosis,” said Dr. Ruddy. It is generally recommended that women with a diagnosis of breast cancer start chemotherapy within 8 weeks. In general, egg harvesting requires 1-6 weeks.
The fact that many newly diagnosed breast cancer patients are concerned about fertility but are not taking advantage of available technology for fertility preservation suggests that many women may not be getting the right information at the right time.
“I think it’s important that we find out what the educational and financial barriers to fertility preservation techniques are for cancer patients across the country,” said Dr. Ruddy. “We need to assure that young women are able to make choices about fertility preservation that best meet their needs.”
Kathryn Ruddy, MD, MPH, is an Assistant Professor of Oncology and Director of Cancer Survivorship for the Department of Oncology Mayo Clinic in Rochester, MN. She has been an ASCO member since 2006.
Click here to read the abstract.
Click here to view a PDF of the full article.
Ruddy, KJ, Gelber, S, Tamimi, RM, et al. A prospective study of fertility concerns and preservation strategies in young women with breast cancer. J Clin Oncol. 2014; Published online ahead of print 2.24.2014.
The Exclusive Coverage series on ASCO.org highlights selected research from JCO with additional perspective provided by the lead or corresponding author.
@ 2014 American Society of Clinical Oncology