Abstract
BackgroundOffering ovarian function and/or fertility preservation strategies in premenopausal women with newly diagnosed breast cancer candidates to undergo chemotherapy is standard of care. However, few data are available on uptake and main reasons for refusing these options.MethodsThe PREFER study (NCT02895165) is an observational, prospective study enrolling premenopausal women with early breast cancer, aged between 18 and 45 years, candidates to receive (neo)adjuvant chemotherapy. Primary objective is to collect information on acceptance rates and reasons for refusal of the proposed strategies for ovarian function and/or fertility preservation available in Italy.ResultsAt the study coordinating center, 223 patients were recruited between November 2012 and December 2020. Median age was 38 years (range 24 – 45 years) with 159 patients (71.3%) diagnosed at ≤40 years. Temporary ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) was accepted by 58 out of 64 (90.6%) patients aged 41-45 years and by 151 out of 159 (95.0%) of those aged ≤40 years. Among patients aged ≤40 years, 57 (35.8%) accepted to access the fertility unit to receive a complete oncofertility counseling and 29 (18.2%) accepted to undergo a cryopreservation technique. Main reasons for refusal were fear of delaying the initiation of antineoplastic treatments and contraindications to the procedure or lack of interest in future childbearing. Patients with hormone-receptor positive breast cancer had a tendency for a higher acceptance rates of ovarian function and/or fertility preservation strategies than those with hormone-receptor negative disease.ConclusionsMore than 90% of premenopausal women with early breast cancer, and particularly those with hormone receptor-positive disease, were concerned about the potential risk of chemotherapy-induced premature ovarian insufficiency and/or infertility and accepted GnRHa administration. Less than 1 out of 5 women aged ≤40 years accepted to undergo cryopreservation strategies.
Highlights
Among women of reproductive age, breast cancer is the most frequent diagnosed malignancy [1]
From November 2012 to December 2020, 223 consecutive newly diagnosed premenopausal breast cancer patients were included at the Breast Unit of the coordinating center
Performing a complete oncofertility counseling to discuss the potential risk of chemotherapy-induced premature ovarian insufficiency (POI) and infertility and to offer the available strategies for ovarian function and/or fertility preservation is mandatory in all premenopausal women with new cancer diagnosis [7,8,9,10], limited evidence exists on the actual use of these techniques [14]
Summary
Among women of reproductive age, breast cancer is the most frequent diagnosed malignancy [1]. The long-term side effects of chemotherapy including the potential damage to women’s ovarian function and fertility potential are of high concern for a significant proportion of women diagnosed during their reproductive age [4, 5]. Two main approaches are available for trying to counteract the long-term side effects of chemotherapy on breast cancer patients’ reproductive health [6]. Ovarian function preservation aims to reduce the potential long-term side effects of chemotherapy-induced premature ovarian insufficiency (POI) that include menopause-related symptoms, psychosocial issues and other health problems [4]. This approach can be of importance to patients not interested in future conception. Few data are available on uptake and main reasons for refusing these options
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