Younger patients with breast cancer may decline tamoxifen due to fertility concerns.

Abstract

Although endocrine therapy such as tamoxifen can reduce the risk of breast cancer recurrence and mortality, younger patients may decline or discontinue it early if they have concerns about their fertility, according to a recently published study.1 Jacqueline Jeruss, MD, PhD, of the University of Michigan Medical School, and colleagues conducted the study of 515 premenopausal patients to explore the reasons why this scenario occurs. The women, all aged younger 45 years, had stage 0 to III hormone receptorpositive breast cancer for which treatment with tamoxifen was recommended. Researchers evaluated chart reviews to obtain data concerning demographics, disease, and patient concerns. Women who declined or discontinued tamoxifen also were interviewed by telephone. Women who received a diagnosis of ductal carcinoma in situ and declined radiotherapy, did not receive chemotherapy, had a history of smoking, or who had fertility concerns were all less likely to initiate tamoxifen treatment or were more likely to discontinue it early. The primary reasons they gave for not initiating, delaying, or discontinuing treatment were concerns regarding side effects or the ability to become pregnant. The researchers note that despite the availability of fertility preservation options and the relative safety of pregnancy among survivors of breast cancer, fertility preservation is often underutilized and underdiscussed with clinicians.