Abstract
Background: In the last decades, long-term outcomes of breast cancer (BC) patients have improved, raising new survivorship issues, including fertility preservation and safety of pregnancy after BC. This study assesses evolution in patterns of fertility discussion/preservation over time and reports pregnancy outcomes in a cohort of young BC patients.Methods: A retrospective cohort of 590 BC patients aged ≤40 diagnosed between 2000 and 2016 at a large cancer center was identified. Fertility counseling and preservation patterns for patients receiving chemotherapy were analyzed and compared for two cohorts: 2004–2006 and 2014–2016 (total n = 161). Outcomes were reported for patients with documented pregnancy after BC.Results: Significantly, more patients diagnosed in 2014–2016 had evidence of discussion on fertility issues and/or application of fertility preservation techniques versus patients diagnosed in 2004–2006 (82.9% vs. 66.0%, p = 0.017). In particular, there was a significant difference in rate of documented fertility issues discussion (67.6% vs. 34.0%, p < 0.001). Age >35 and parity were associated with lower rates of fertility discussion/preservation. However, rates significantly improved over time (77.6% in 2014–2016 vs. 58.1% in 2004–2006 for patients aged >35, p = 0.046; 80.7% in 2014–2016 vs. 57.6% in 2004–2006 for patients with children at diagnosis, p = 0.018). Twenty-six patients with pregnancy after BC were identified; eight delivered at the age of >40. No complications for women or newborns were reported. Only two patients experienced BC relapse.Conclusions: In this small retrospective cohort, no safety concerns were identified for pregnancy after BC. The importance attributed by clinicians to address fertility issues has increased over time.
Highlights
Breast cancer (BC) is the most common malignancy in women, accounting for 1.67 million new cancer cases diagnosed in 2012 worldwide,[1] with more than 10% of new cases diagnosed in women younger than the age of 40 years.[2]
To assess variations in fertility preservation patterns over time, we considered young patients who received adjuvant or neoadjuvant chemotherapy and who were diagnosed in years 2004–2006 (n = 50, 6% of total patients diagnosed in that period) or in years 2014–2016 (n = 111, 6% of total patients diagnosed in that period) (Supplementary Fig. S1)
There was a significant difference in the frequency of documentation of fertility issues discussion according to time cohort: 75 out of 111 (67.6%) patients diagnosed in years 2014–2016 had documentation in medical records of discussion of fertility issues versus 17 (34.0%) of the 50 patients diagnosed in years 2004– 2006 ( p < 0.001)
Summary
Breast cancer (BC) is the most common malignancy in women, accounting for 1.67 million new cancer cases diagnosed in 2012 worldwide,[1] with more than 10% of new cases diagnosed in women younger than the age of 40 years (more than 190,000 new cases estimated worldwide in2012).[2]. With more than 50,000 estimated new cases in 2017, and accounts for almost half (41%) of the malignancies diagnosed in women younger than the age of 50 years.[3]. BC mortality has consistently decreased,[1] thanks to the extensive use of screening and advances in adjuvant systemic treatments Both chemotherapy and endocrine treatment may affect the reproductive function of young BC patients. Long-term outcomes of breast cancer (BC) patients have improved, raising new survivorship issues, including fertility preservation and safety of pregnancy after BC. This study assesses evolution in patterns of fertility discussion/preservation over time and reports pregnancy outcomes in a cohort of young BC patients. Methods: A retrospective cohort of 590 BC patients aged £40 diagnosed between 2000 and 2016 at a large cancer center was identified.
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