58 - Oncofertility Options for Young Women With Breast Cancer

Abstract

Breast cancer is the most common cancer diagnosed in women in the United States. Approximately 12% of breast cancers are diagnosed in women younger than 44 years of age. The 5-year relative survival rate for early-stage breast cancer is approximately 98%, yet younger women, diagnosed before age 40, have a 5-year relative survival rate closer to 85%. Emerging treatments for breast cancer continue to result in improved outcomes, although some of these successful therapies have comorbidities, including long-term effects on the ovaries, resulting in premature ovarian failure and reduced fertility. The concept of fertility preservation, or oncofertility, was first proposed with the goal of improving posttreatment reproductive outcomes for young patients diagnosed with cancer. The interdisciplinary Oncofertility Consortium of physicians and scientists was consequently created and supported by the National Institute of Health. Currently, several societies including the American Society of Clinical Oncology (ASCO), the American Society of Reproductive Medicine (ASRM), and the National Comprehensive Cancer Network (NCCN) have guidelines advocating for counseling of young cancer patients regarding fertility preservation before the initiation of treatment. Understanding ovarian biology in the context of a cancer diagnosis in young women and the existing and emerging options to protect hormonal and reproductive health is of importance to the patients and is reviewed in this chapter.