Outcomes In Young Women Research Articles

Abstract P1-02-06: Improved survival with ovarian function suppression in premenopausal hormone receptor-positive breast cancer: a propensity score matching of ASTRRA-trial participants with single-center postmenopausal patients

Abstract Background: Poor survival outcome in young women with hormone-sensitive breast cancer was reported. And previous studies have demonstrated that the addition of ovarian function suppression (OFS) significantly improved disease-free survival (DFS) in patients with premenopausal hormone receptor–positive breast cancer. In this study, we examined whether ovarian function suppression treatment in premenopausal women is effective in survival comparable to postmenopausal status. Methods: We evaluated 1,298 breast cancer patients included in the post-trial follow-up of the Addition of Ovarian Suppression to Tamoxifen in Young Women With Hormone-Sensitive Breast Cancer Who Remain Premenopausal or Regain Vaginal Bleeding After Chemotherapy (ASTRRA) trial who received either tamoxifen (TAM) only (n=647) or TAM + OFS (n=635), randomly assigned in a 1:1 ratio and postmenopausal patients in AMC (Asan Medical Center; Seoul, Korea) treated with aromatase inhibitor (AI) (n=603). All patients analyzed in this study underwent surgery between March 2009 and November 2011. The primary endpoint was disease-free survival (DFS) and the secondary endpoint was overall survival (OS). We use propensity-score matching by lymph node status, tumor size, tumor grade, histologic type of cancer, human epidermal growth factor receptor-2 (HER2) status, chemotherapy regimen, surgical modality, and radiotherapy in the overall cohort and in separate subgroups according to anti-hormonal therapy regimens. Results: In the overall matched cohort, there was a significant difference between the postmenopausal AI group and premenopausal Tam only group in DFS (hazard ratio for the postmenopausal AI group, 0.654; 95% CI, 0.432 to 0.991) and OS was not significantly different between the premenopausal Tam only group and postmenopausal AI group (p=0.061). On the other hand, there was no significant difference between the postmenopausal AI group and premenopausal Tam+OFS group in disease free survival (hazard ratio for the postmenopausal AI group, 1.156; 95% confidence interval [CI], 0.735 to 1.820) or the overall survival (hazard ratio for the postmenopausal AI group, 1.04; 95% CI, 0.553 to 1.956). Conclusion: This study’s findings suggest that the poor prognosis of young women with hormone-sensitive breast cancer is improved by adding OFS to Tam and the effect is not inferior to that of using AI in post-menopausal women. Outcomes in a Cohort of Patients Matched for Propensity Scores postmeno AI, postmenopausal patients who treated with aromatase inhibior in Asan Medical Center; premeno Tam+OFS, premenopausal ASTRRA participants who treated with tamoxifen and ovarian function suppression; premeno Tam, premenopausal ASTRRA participants who treated with tamoxifen only Citation Format: Young-jin Lee, Tae-Kyung Yoo, Sae Byul Lee, Jisun Kim, Il-Yong Chung, Beom Seok Ko, Jong Won Lee, Byung Ho Son, Sei Hyun Ahn, Seonok Kim, Hee Jeong Kim. Improved survival with ovarian function suppression in premenopausal hormone receptor-positive breast cancer: a propensity score matching of ASTRRA-trial participants with single-center postmenopausal patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-02-06.

Height, wealth, and schooling outcomes in young women from lower- and middle-income countries.

This study evaluates a large (N > 366,000) sample of young women (15-18 years) from 64 lower- and middle-income countries for associations between height, household wealth, and schooling outcomes, with a focus on secondary school attendance. A pooled sample and regional samples (Latin America, South/Southeast Asia, East Africa, and West Africa) are evaluated. A dual purpose is to evaluate both associations between height and schooling, and potential height-wealth interactions such that height associations to schooling vary over levels of wealth. Ordered probit analysis indicates positive marginal probabilities from height on secondary school attendance in all samples, with diminishing probabilities in the Latin America and South/SE Asia samples, and flat/increasing probabilities in the African samples. For South/SE Asia and taller women in Latin America, height associations are stronger at lower household wealth. For both African samples and shorter women in Latin America, height associations are stronger at higher wealth. The findings suggest that the height-schooling relationship may derive from the influence from early-life health, and may also be affected by differences in health and education environments as suggested by variations across regions and height-wealth interactions within regions.

Clinical Outcomes in Younger Women Hospitalized With an Acute Myocardial Infarction: A Contemporary Population-Level Analysis.

For younger women with acute myocardial infarction (AMI), little is known regarding their contemporary care pathways and clinical outcomes. We studied AMI patients aged 18-55 years, hospitalized from April 1, 2009, to March 31, 2019, in Ontario, Canada. We compared trends in comorbidities, angiographic findings, and revascularisation rates in men and women. The primary outcome was 1-year all-cause mortality or readmission for unstable angina, AMI, heart failure, or stroke. Inverse probability of treatment weighting was used to account for differences in baseline clinical characteristics between men and women. Among the 38,071 AMI patients included, 8,077 (21.2%) were women. Over the study period, women had increasing rates of diabetes (24.8% to 34.9%; Ptrend < 0.001), and declining rates of smoking (53.2% to 41.7%; Ptrend < 0.005). Although most patients received coronary angiography (96%), coronary revascularisation was less frequent among women than men (percutaneous coronary intervention: 61.9% vs 78.8% [P < 0.001]; surgery: 4.1% vs 6.0% [P < 0.001]). Women had more normal coronary anatomy (5.8% vs 1.7%; P < 0.001) and nonobstructive disease (22.8% vs 9.3%; P < 0.001) than men. Compared with men, the primary composite end point was significantly increased among women (10.0% vs 7.9%, adjusted HR 1.11; P= 0.02) and related to increased readmission rates for cardiovascular events. All-cause readmission was significantly increased among women (25.8% vs 21.1%, adjusted HR 1.34; P < 0.0001). Coronary angiography is performed almost universally in younger women with AMI; however, coronary revascularisation is less frequent, perhaps reflecting less obstructive disease. Although mortality rates after AMI were similar between sexes, cardiovascular readmission rates and all-cause readmissions were significantly increased among women.

Very long-term outcomes after acute myocardial infarction in young men and women

Abstract Aims There is a paucity of data on very long-term outcomes in young women and men experiencing acute myocardial infarction (AMI). Methods and results The FAST-MI program consists of three nationwide French surveys carried out 5 years apart from 2005 to 2015, including consecutive AMI patients over a 1-month period with up to 10-year follow-up. The present analysis focused on adults ≤50 yo according to their gender. Women accounted for 17.5% (N=335) of the 1912 patients under 50 yo and were as old as men (43.9±5.5 vs. 43.9±5.1yo, p=0.92). Non-significant coronary artery disease was more frequent in women (12.8% vs. 5.8%, P&amp;lt;0.001). Women with significant coronary artery disease underwent less percutaneous coronary internvention (PCI) than men (85.9% vs. 91.3%, p=0.005), though primary PCI in ST-elevated myocardial infarction was as frequent in women (67.3% vs. 66.8%). Recommended secondary prevention medications were less prescribed at discharge in women (40.6% vs. 52.8%, p&amp;lt;0.001), a trend that persisted in 2015 (59.1% vs. 72.8% in 2015, p&amp;lt;0.001). Still, ten-year survival was similar in men (90.5%) and women (92.6%) (crude HR 0.87 [95% CI 0.55–1.57], adjusted HR 0.77 [95% CI 0.48–1.23], p=0.27) even among hospital survivors (adjusted HR 0.64 [95% CI 0.32–1.30], p=0.22). Ten-year survival was similar in patients with myocardial infarction with non-obstructive coronary arteries compared with those with significant coronary artery disease (91.8% vs. 91.0%, P=0.46)), both among men (91.6% vs. 90.7%) and women (92.9% vs. 93.0%). However, when taking into account early revascularization and discharge medications, in patients with significant coronary artery disease, adjusted 10-year mortality was significantly lower in women (HR 0.53, 95% CI 0.29–0.96, P=0.04). Conclusions Ten-year survival in young women with AMI is similar to that of men. However, in those with significant coronary artery disease, improving secondary prevention in women should result in better long-term outcome. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): French Society of Cardiology

Protocol of trans-Tasman feasibility randomised controlled trial of the Younger Women’s Wellness After Breast Cancer (YWWACP) lifestyle intervention

BackgroundYounger women (defined as those < 50 years who are likely pre-menopausal at time of diagnosis) with breast cancer often experience persistent treatment-related side effects that adversely affect their physical and psychological wellbeing. The Women’s Wellness After Cancer Program (WWACP) was adapted and piloted in Australia to address these outcomes in younger women. The aims of this feasibility study are to determine (1) the potential to translate the Younger WWACP (YWWACP) intervention to a broader population base in Aotearoa/New Zealand and Australia, and (2) the potential for success of a larger, international, phase ΙΙΙ, randomised controlled trial.MethodsThis bi-national, randomised, single-blinded controlled trial involves two main study sites in Aotearoa/New Zealand (Kōwhai study) and Australia (EMERALD study). Young women aged 18 to 50 years who completed intensive treatment (surgery, chemotherapy, and/or radiotherapy) for breast cancer in the previous 24 months are eligible. The potential to translate the YWWACP to women in these two populations will be assessed according to several feasibility outcomes. These include examining intervention accessibility, acceptability and uptake; intervention sustainability and adherence; the prevalence components of the intervention in the control group; intervention efficacy; participants’ perception of measurement burden; the effectiveness of planned recruitment strategies; and trial methods and procedures. The studies collectively aim to enrol 60 participants in the intervention group and 60 participants in the control group (total = 120 participants).DiscussionEthical approval has been received from the Southern Health and Disability Ethics Committee (Kōwhai ref: 19/STH/215), and UnitingCare Human Research Ethics Committee (EMERALD ref: 202103). This study will provide important data on the feasibility of the refined YWWACP in the trans-Tasman context. This study will account for and harmonise cross-country differences to ensure the success of a proposed international grant application for a phase ΙΙΙ randomised controlled trial of this program to improve outcomes in younger women living with breast cancer.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): Kōwhai ACTRN12620000260921, registered on 27 February 2020. EMERALD ACTRN12621000447853, registered on 19 April 2021.

Risk of recurrence and pregnancy outcomes in young women with breast cancer who do and do not undergo fertility preservation.

To assess the impact of fertility preservation (FP) requiring ovarian stimulation on breast cancer outcomes and pregnancy after breast cancer. Women aged ≤ 40years diagnosed with stage I-III breast cancer between 2007 and 2018 and referred for FP consultation prior to systemic therapy were identified from a British Columbia fertility center database. The primary endpoint was invasive breast cancer-free survival (iBCFS) and secondary endpoints were overall survival (OS) and achievement of pregnancy. Survival and pregnancy endpoints were compared using Cox and logistic regression analyses, respectively, for patients who did and did not undergo FP. The study included 153 patients, with 71 (46%) in the FP group and 82 (54%) in the non-FP group. Patients who underwent FP were more likely to be ECOG 0 (99% vs. 88%, p = 0.011) and receive chemotherapy (93% vs. 67%, p < 0.001), but had similar ER positivity status to non-FP patients (70% vs. 79%, p = 0.21). Over a median follow-up of 4.1years, there were no differences in iBCFS (HR 1.006, 95% CI 0.416-2.438, p = 0.988) or OS (HR 0.789, 95% CI 0.210-2.956, p = 0.725) between FP and non-FP groups. Patients who underwent FP had higher odds of conceiving at least once (OR 3.024, 95% CI 1.312-6.970, p = 0.008). At a median follow-up of 4.1years, FP did not impact iBCFS or OS, supporting its safety in young women with breast cancer. In addition, patients who underwent FP were more likely to become pregnant after breast cancer, highlighting the value of pre-oncologic treatment FP in survivorship family planning.

Intrauterine Device Outcomes in Young Women with Heavy Menstrual Bleeding: Comparing Patients with and without Inherited Bleeding Disorders

To evaluate the use of intrauterine devices (IUDs) in two young women's hematology clinics and compare adverse events in adolescents with and without inherited bleeding disorders (BDs) DESIGN: Retrospective multicenter cohort study from February 2014 through February 2020 SETTING: Young women's hematology clinics at Nationwide Children's Hospital in Columbus, Ohio, and Children's Medical Center in Dallas, Texas PARTICIPANTS: Female patients evaluated for heavy menstrual bleeding (HMB) who underwent IUD placement INTERVENTIONS AND MAIN OUTCOME MEASURES: Rates of IUD expulsion, malposition, and ongoing HMB requiring additional medical treatment RESULTS: We identified 43 patients with BDs and 35 patients without BDs who underwent placement of an IUD for HMB. The mean age was 14.9 years (range 11.0-21.4 years) at the time of presentation and 15.8 years (range 11.0-21.4 years) at IUD placement. Those with BDs were younger at the time of IUD insertion. Most patients (90%) had previously failed other methods to control HMB. The annual rate of IUD adverse events was 0.25 per year of use, and all adverse events occurred in the first 20 months after placement. There were no significant differences in adverse IUD events in patients with and without BDs, although those without BDs requested IUD removal more frequently. In this cohort of adolescent females, the presence of a BD was not associated with a higher IUD expulsion rate. IUD placement should be considered a first-line option for adolescents with BDs who experience HMB.

Fertility preservation decisions and outcomes of young women with breast cancer.

e12520 Background: As breast cancer (BC) survival improves, fertility preservation (FP) counselling prior to initiating gonadotoxic chemotherapy for women of child-bearing age becomes more important. This study explores the factors that influence the decisions to pursue FP before and after breast cancer treatment and the FP outcomes. Methods: An IRB approved web-based survey examining decisions about FP, factors influencing decisions, and post-decision regret was administered to English and Spanish speaking women (age 18-45) diagnosed with stage I-III BC. All women received education and counselling by a MSK Fertility Nurse Specialist prior to initiating cancer treatment at MSKCC in 2009-2017. Additional data was extracted from the medical record. Results: 211 women with BC (82% ER+, 19% HER-2+, 12% triple negative) with a mean age of 34 (age range 20-45) participated in this study. At the time of diagnosis 128 (61%) women were married/living with partner and 46 (22%) women had children. 151 (72%) wanted (additional) children, 48 (23%) were unsure if they wanted (additional) children and 12 (6%) did not want (additional) children. Of the 151 women who desired (additional) children, 94 underwent FP pre-treatment and 3 post-treatment. Of 48 unsure women, 14 underwent FP. A total of 115 women underwent FP before treatment: 73 froze eggs and 49 froze embryos. After treatment 28 (13%) women met with a reproductive endocrinologist and 13 underwent FP: 9 froze eggs and 4 froze embryo. The average number of eggs frozen was 14 pre-treatment and 18 post-treatment. The average number of embryos frozen was 7 both pre- and post-treatment. After completing primary breast cancer treatment, 61 women opted to try to build their family and 42 had children: 35 gave birth and 7 used a surrogate. In a multivariate analysis lower socioeconomic status and non-white race were predictive of discordance between desire for FP and completion of FP before treatment (p &lt; 0.05). 65% of patients reported cost of freezing eggs/embryos was important in their decision. Insurance did not cover any FP treatment for 56/115 (49%) of women and 34% (39/115) of women paid $10,000 or more for their FP. Participants reported the ability to feel hopeful about their future (82%) and fear of regret (80%) were the most important factors when making their FP decision. 83% (176/211) of women believe they made the right FP decision and 80% would make the same decision again. Women had less regret if they underwent FP. Conclusions: Our study demonstrates the importance of discussing FP with women with BC of child-bearing age, regardless of race or economic status. Fertility preservation is often successful in women with BC. Regardless of pregnancy outcomes, women felt that having FP offered them a sense of control and hope for the future during a vulnerable time in their lives with low risk of regret.

Estradiol (E2) levels in premenopausal women with hormone receptor-positive (HR+) breast cancer (BC) on ovarian function suppression (OFS) with gonadotropin-releasing hormone agonists (GnRHa).

524 Background: OFS is an important treatment component for premenopausal women with early and advanced HR+ BC and optimal efficacy may depend on complete E2 suppression with GnRHa, especially when combined with aromatase inhibitors (AI). However, standard assays lack sensitivity and accuracy at very low E2 concentrations, rendering detection of breakthrough ovarian function challenging. More informative data regarding endocrine effects of GnRHa are needed, particularly in young women who derive the most benefit from OFS yet more frequently had breakthrough E2 levels in the SOFT trial substudy, SOFT-EST. Methods: Using a prospective cohort study of women with BC diagnosed at age ≤ 40 years, we identified participants with stage I-IV HR+ BC on OFS treatment with leuprolide, goserelin or triptorelin and blood collected 1 year after diagnosis. Clinical data were obtained through surveys and medical records. Plasma estrogens were measured by liquid chromatography-tandem mass spectrometry, with a limit of detection of 0.2 pg/mL compared to 10 pg/mL with standard assays. We assessed the proportion of women on OFS with E2 &gt; 2.72 pg/mL (10 pmol/L) and &gt; 10 pg/mL. Patient characteristics, estrone (E1) and FSH levels, and disease-free (DFS) and overall survival (OS) were compared between those with and without elevated E2 using Fischer’s exact, Wilcoxon rank sum and log rank tests, respectively. Results: Of 84 patients who met inclusion criteria, 72 (86%) had stage I-III and 12 (14%) had stage IV BC; 25 were on OFS plus AI and 59 were on OFS plus tamoxifen (TAM). Median E2 was 3.1 pg/mL (range 0.2-30.9). 46 patients (55%) had E2 &gt; 2.72 pg/mL, including 8 on AI and 38 on TAM; 4 (5%) had E2 &gt; 10 pg/mL, including 1 on AI and 3 on TAM. Factors associated with E2 &gt; 2.72 pg/mL were no prior chemotherapy, TAM and high E1 ( P ≤.05), but not age, BMI or GnRHa schedule (Table). After a median follow-up of 7 years, DFS events were seen in 6 patients with E2 &gt; 2.72 pg/mL and 5 without ( P =.232); OS events were seen in 7 patients with E2 &gt; 2.72 pg/mL and 5 without ( P =.608). Conclusions: More than half of young women with ER+ BC had E2 &gt; 2.72 pg/mL on OFS, 91% of whom would not have been detected by standard assays. This may be an area amenable to intervention to improve outcomes in young women. However, larger studies are needed to elucidate the optimal E2 target on OFS and clinical implications of incomplete E2 suppression on ultrasensitive assays. [Table: see text]

Patterns of care and survival outcomes for young women treated for early breast cancers in a community hospital system.

e12586 Background: Younger women with breast cancer have relatively poor prognosis and higher rates of locoregional recurrence. Epidemiologic data suggest equivalent survival with mastectomy or breast conserving surgery (BCS) in this population. We analyzed patterns of care and survival outcomes for women aged &lt; 45 years with breast cancer treated at Ascension Macomb Oakland Hospital (AMOH), Ascension St John Hospital (ASJH), and Ascension Providence Hospital (APH). Methods: Between 2006 and 2015 there were 4703 patients treated for breast cancers at AMOH, ASJH, and APH. We identified a subset of 319 patients aged &lt; 45 treated for breast cancers and investigated patients' tumor characteristics, type of surgery, and overall survival by using the Metric database and reviewing patient charts. Kaplan-Meier analysis and log-rank tests together with univariate analysis was done by using SAS for Windows 9.4. Results: With median follow-up of 53 months among living patients, 26 patients had died. African American race was associated with decreased overall survival (log-rank p=0.0031). Factors associated with improved overall survival included AJCC stage grouping (p=0.009), estrogen receptor (p=0.0004) or progesterone receptor positivity (p=0.005), or HER2 negativity (p=0.039). Similarly, survival was different according to grouping cases as luminal A (n=174), luminal B (n=39), basal (n=46), HER2 (n=23) and unknown phenotype (n=37) (P=0.008). Considering all cases 91 were treated with BCS (28.5%) and 228 with mastectomy (71.4%; 113 unilateral and 115 bilateral with or without reconstruction). Conclusions: In this group of young women, overall survival was influenced by stage and breast cancer phenotype as expected. African American race was associated with inferior overall survival. We found high rates of mastectomy with or without reconstruction. In the future comprehensive disease profiling will help to direct decision making.

Influence of breast cancer prognostic factors on oocyte in vitro maturation outcomes performed for urgent fertility preservation.

Do breast cancer (BC) characteristics influence IVM of oocytes outcomes in patients undergoing fertility preservation (FP)? Scarff-Bloom-Richardson (SBR) III grade, triple-negative BC and HER2 overexpression are independent predictors of fewer oocytes or poor IVM outcomes in young women seeking FP. SBR grade, triple-negative status and overexpression of HER2, as well as a high Ki67 proliferation index are all established prognostic factors for BC, influencing patients' therapeutic management. Yet there are also concerns about the potential impact of cancer status on ovarian reserve and function. Previous studies analysing the results of ovarian stimulation in BC patients have shown conflicting findings. Nevertheless, there is no data on the potential impact of BC status and prognostic factors on IVM outcome in women undergoing urgent FP. We studied 321 BC patients, 18 to 41 years of age, who were also candidates for oocyte cryopreservation following IVM. The number of oocytes recovered, maturation rate and total number of cryopreserved oocytes were assessed. Ovarian reserve markers (antral follicle count [AFC] and serum anti-Müllerian hormone [AMH] levels) and IVM outcomes were compared according to BC characteristics (Ki67 proliferation index >20%, progesterone and/or oestrogen receptors expression, HER2 status and SBR grade). Logistic regression analysis was then performed to determine the variables that could be independently associated with poor IVM outcomes, such as oocyte retrieval rate <50%, oocyte maturation rate <60% and total number of frozen oocytes <5. Overall, the mean age of the population was 32.3 ± 4.1 years. Mean AFC and serum AMH levels were 22.8 ± 13.9 follicles and 3.8 ± 3.1 ng/ml, respectively. AMH levels were significantly lower in case of triple-negative BC when compared with ER/PR/HER2 status positive cancer (3.1 ± 2.6 ng/ml vs 4.0 ± 3.3 ng/ml, P = 0.02). The mean number of recovered oocytes was 10.2 ± 9.1. After a mean maturation rate of 58.0 ± 26.1%, 5.8 ± 5.3 mature oocytes were cryopreserved per cycle. The number of retrieved and cryopreserved oocytes after IVM were significantly lower in patients presenting with an SBR III tumour when compared with an SBR I or II tumour (9.6 ± 8.7 vs 11.7 ± 9.8, P = 0.02 and 5.4 ± 5.4 vs 6.6 ± 5.8, P = 0.02, respectively). Multivariate statistical analysis showed that HER2 positive status was associated with a mean maturation rate <60% (odds ratio: 0.54; 95% CI (0.30-0.97)). Ki67 and hormonal status were not correlated with poor IVM outcomes. A weakness is the retrospective nature of the study. Moreover, as with many studies focusing on FP in oncology patients, the lack of data after reutilization of IVM oocytes prevents drawing reliable conclusions on the fate of these frozen gametes. BC prognostic factors might influence IVM outcomes. Moreover, HER2 is likely to be involved in the ovarian function and oocyte maturation process. Further investigations are needed to better understand the mechanisms at play and their possible impact on the competence of IVM oocytes. No specific funding was used and there are no conflicts of interest. N/A.

Risk of Adverse Pregnancy Outcomes in Young Women with Thyroid Cancer: A Systematic Review and Meta-Analysis.

Simple SummaryThis meta-analysis of 22 articles investigated whether thyroidectomy or radioactive iodine treatment (RAIT) in patients with differentiated thyroid cancer was associated with an increase in adverse pregnancy outcomes, such as miscarriage, preterm delivery, and congenital malformations. The results of this meta-analysis suggest that thyroid cancer treatment, including RAIT, is not associated with an increased risk of adverse pregnancy outcomes, including miscarriage, preterm labor, and congenital anomalies.This meta-analysis investigated whether thyroidectomy or radioactive iodine treatment (RAIT) in patients with differentiated thyroid cancer (DTC) was associated with an increase in adverse pregnancy outcomes, such as miscarriage, preterm delivery, and congenital malformations. A total of 22 articles (5 case-control and 17 case series studies) from 1262 studies identified through a literature search in the PubMed and EMBASE databases from inception up to 13 September 2021 were included. In patients with DTC who underwent thyroidectomy, the event rates for miscarriage, preterm labor, and congenital anomalies were 0.07 (95% confidence interval [CI], 0.05–0.11; 17 studies), 0.07 (95% CI, 0.05–0.09; 14 studies), and 0.03 (95% CI, 0.02–0.06; 17 studies), respectively. These results are similar to those previously reported in the general population. The risk of miscarriage or abortion was increased in patients with DTC when compared with controls without DTC (odds ratio [OR], 1.80; 95% CI, 1.28–2.53; I2 = 33%; 3 studies), while the OR values for preterm labor and the presence of congenital anomalies were 1.22 (95% CI, 0.90–1.66; I2 = 62%; five studies) and 0.73 (95% CI, 0.39–1.38; I2 = 0%; two studies) respectively, which showed no statistical significance. A subgroup analysis of patients with DTC according to RAIT revealed that the risk of miscarriage, preterm labor, or congenital anomalies was not increased in the RAIT group when compared with patients without RAIT. The results of this meta-analysis suggest that thyroid cancer treatment, including RAIT, is not associated with an increased risk of adverse pregnancy outcomes, including miscarriage, preterm labor, and congenital anomalies.

Management and Outcome of Young Women (≤40 Years) with Breast Cancer in Switzerland.

Simple SummaryData on the outcome and treatment of young women with breast cancer (BC) in Switzerland is scarce. We conducted a retrospective cohort study to evaluate treatment and outcome of women aged ≤ 40 years, diagnosed with stage I-III BC in Switzerland between 2000–2014. We found that the majority of patients were treated according to international guidelines, however we identified differences in quality-of-care score across the two Swiss linguistic/geographic regions (Swiss Latin and Swiss German). Survival was high: 91.4% (95% confidence interval (CI) 90.2–92.5) at 5 years and 83.1% (95% CI 81.2–78.5) at 10 years. After adjusting for multiple clinicopathological factors only tumor characteristics and treatment period remained independently associated with survival. We concluded that national guidelines for young women with BC should be implemented to standardize treatment in Switzerland and awareness should be raised among young women and clinicians that BC does not discriminate by age.Background: An increase in breast cancer (BC) incidence in young women (YW) as well as disparities in BC outcomes have been reported in Switzerland. We sought to evaluate treatment and outcome differences among YW with BC (YWBC). Methods: YW diagnosed with stage I-III BC between 2000–2014 were identified through nine cancer registries. Concordance with international guidelines was assessed for 12 items covering clinical/surgical management, combined in a quality-of-care score. We compared score and survival outcome between the two linguistic-geographic regions of Switzerland (Swiss-Latin and Swiss-German) and evaluated the impact of quality-of-care on survival. Results: A total of 2477 women were included. The median age was 37.3 years (IQR 34.0–39.4 years), with 50.3% having stage II BC and 70.3% having estrogen receptor positive tumors. The mean quality-of-care score was higher in the Latin region compared to the German region (86.0% vs. 83.2%, p < 0.0005). Similarly, 5- and 10-year overall survival rates were higher in the Latin compared to the German region (92.3% vs. 90.2%, p = 0.0593, and 84.3% vs. 81.5%, p = 0.0025, respectively). There was no difference in survival according to the score. In the univariate analysis, women in the Latin region had a 28% lower mortality risk compared to women in the German region (hazard ratio 0.72; 95% CI 0.59–0.89). In the multivariable analysis, only stage, differentiation, tumor subtype and treatment period remained independently associated with survival. Conclusions: We identified geographic disparities in the treatment and outcome of YWBC in Switzerland. National guidelines for YWBC should be implemented to standardize treatment. Awareness should be raised among YW and clinicians that BC does not discriminate by age.

Obstetric outcomes of young women following in-vitro fertilization: a case\u2013control study

BackgroundWomen undergoing in-vitro fertilization (IVF) treatments are at increased risk for maternal and neonatal complications compared to women who conceive spontaneously. Though spontaneous pregnancies of young women and adolescents have an increased risk for adverse maternal and neonatal outcomes, pregnancy outcomes of this age group, following IVF treatment have been scarcely reported. The aim of this study was to report maternal and neonatal outcomes of young women who conceived following IVF compared to women in the same age group with spontaneous conception.MethodsWe performed a multicenter case–control study. The study group included women aged 17–25 years who conceived by IVF with an ongoing singleton pregnancy. For the purpose of the study, a control group matched (1:2 ratio) for maternal age at delivery and parity was constructed. Demographic, medical history, pregnancy related characteristics and maternal and neonatal outcomes were compared between groups. Finally, factors associated with spontaneous vaginal delivery were assessed for the entire cohort using a univariate and multivariate logistic regression model.ResultsBetween 2005 and 2021, we identified 80 women aged 19–25 years who conceived by IVF. A control group of 160 women was matched to the study group by age and parity. The unmatched maternal characteristics and pregnancy associated complications were similar among the groups. However, the IVF group had a significantly higher rate of induction of labor (48.1% vs. 26.6%, p = 0.001), meconium-stained amniotic fluid (27.6% vs. 14.1%, p = 0.025), prolonged second stage of labor (26.0% vs. 7.3%, p = 0.001) and operative vaginal delivery (22.5% vs.12.5%, p = 0.048).Neonatal outcomes were for the most part comparable; nevertheless, we found a higher rate of neonates with an umbilical artery pH < 7.1 in the IVF group (9.8% vs. 0.0%, respectively; p = 0.022).A logistic regression analysis for spontaneous vaginal delivery (vs. cesarean or operative vaginal deliveries) found that spontaneous onset of labor (vs. induction of labor) (OR = 2.08; 95% CI = 1.07–4.05, p = 0.03) was positively associated with spontaneous vaginal delivery while prolonged second stage of labor (OR = 0.35; 95% CI = 0.13–0.95, p = 0.04) was negatively associated with this parameter.ConclusionYoung women who conceive by in-vitro fertilization are expected to reach favorable pregnancy outcomes, comparable to women who conceived spontaneously.

Long-term follow-up of a randomized controlled trial comparing systemic family therapy (FT-S) added to treatment as usual (TAU) with TAU alone in adolescents with anorexia nervosa.

Randomized controlled trials showed the efficacy of family therapy for anorexia nervosa during adolescence, but studies examining its long-term beneficial effect are still needed. This article presents the results of a 54-month post-randomization follow-up of a previously reported randomized controlled trial that compared two post-hospitalization outpatient treatment programs: Treatment As Usual alone versus Systemic Family Therapy added to Treatment As Usual. A consecutive series of 60 female adolescents with anorexia nervosa (DSM-IV) were randomized (30 per group). During the first 18 months, in the Treatment As Usual group, subjects received a multidisciplinary treatment. In the other group, Systemic Family Therapy sessions targeting intra-familial dynamics were added to Treatment As Usual. At 54 months, the primary outcome was defined using the Morgan and Russell global Outcome Categories (Good or Intermediate versus Poor). Secondary outcomes were the Global Outcome Assessment Schedule score, body mass index, amenorrhea, number of hospitalizations, eating disorder symptoms, psychopathological features, and family functioning. Analyses were carried out using an Intention-To-Treat with the Last Observation Carried Forward procedure. Data of 59/60 subjects were available. At 54 months, significant effects in favor of adding Systemic Family Therapy to Treatment As Usual were shown for the Global Outcome Categories (60% of Good/Intermediate versus 31% in the control group, p = .026), mean body mass index (p = .048), resumption of menses (70.0% vs. 40% p = .020), and mental state score (p = .010). Family cohesion scores were lower in the Systemic Family Therapy group (p = .040). Adding Systemic Family Therapy focusing on intra-familial dynamics to a multidimensional outpatient treatment program appeared to lead to a better long-term outcome in young women who suffered from severe anorexia nervosa during adolescence.

Abstract P4-11-03: Decisions and outcomes of young women with breast cancer regarding fertility preservation before cancer treatment and family building after treatment

Abstract Background: More than 12,000 new diagnoses of breast cancer occur annually in women &amp;lt;40 years old and most will become survivors. It is recommended that young women with breast cancer be counseled about fertility preservation (FP) options prior to initiation of systemic therapy if they are interested in having biologic children in the future. Decisions to pursue FP are multifactorial and current data suggest only a small proportion of women pursue FP before breast cancer treatment. This study examines the decisions and outcomes of women who pursue FP before treatment and family building after therapy. Methods: An IRB approved web-based cross-sectional survey examining decisions about FP, factors influencing decisions, and post-decision regret was administered to young (age 18-45) breast cancer survivors with stage I-III breast cancer who were either English or Spanish speaking. All women received counseling by a MSK Fertility Nurse Specialist prior to initiating cancer treatment at MSKCC in 2009-2017. Clinical data was also extracted from the medical record .Results: Our sample consisted of 211 women with a mean and median age of 34 (age range was 20-45) and 82% had ER+ disease, 19% had HER-2+ disease and 12% had triple negative breast cancer. At the time of diagnosis, 46 women (22%) had children and 173 women (61%) were married or living with a partner. 151 (72%) of study participants wanted to have (more) children, 48 (23%) were unsure and 12 (6%) did not want additional children. Prior to treatment, 172 (82%) women met with a reproductive endocrinologist (RE), and 122 (58%) underwent FP: 73 froze eggs and 49 froze embryos. After treatment, 28 (13%) women met with a RE, and 13 underwent FP: 9 froze eggs and 4 froze embryos. 26 (12%) patients opted to just use a GnRH agonist during chemotherapy. For women who froze eggs, the average number obtained was 14 pre-treatment and 18 post-treatment. Of those who froze embryos, the average number obtained was 7 both pre- and post-treatment. Concern with financial burden was noted in 58% of women. Insurance did not cover any FP treatment for 56/122 (46%) of women. 32% (39/122) of women paid $10,000 or more for their FP. Women reported that the most important factor that contributed to their FP decision was the ability to feel hopeful about their future followed by concern that they would have regrets if they did not undergo FP. Additional factors that contributed to the FP decision were the desire to have biologic children, feeling overwhelmed by the cancer diagnosis, the cost of freezing eggs or embryos and concern about taking hormone medication. Reflecting back 176 women (83%) believe they made the right decision regarding FP. After completing primary breast cancer treatment, 61 women (29%) opted to try to build their family and 42 had children: 35 gave birth and 7 used a surrogate. Currently 3 women are pregnant, and 10 are pursuing pregnancy. 19 (31%) women conceived without fertility treatment and 22 (36%) women used or are currently pursuing assisted reproduction. 1 woman used a donor egg and 15 successfully used frozen eggs/embryos harvested prior to treatment. Delay of endocrine therapy to pursue pregnancy was uncommon, reported by only 6 women. However, 23 women interrupted endocrine therapy to conceive. Conclusions: The majority of women who attempted family building after treatment were able to have children. Many of these women used eggs/embryos frozen before breast cancer treatment either by getting pregnant themselves or via surrogacy. These data stress the importance of early discussion with a fertility nurse specialist regarding risks and preservation options followed by prompt referral to a reproductive endocrinologist. In addition, FP helped women to feel hopeful about their future and the majority of women believe they made the right decision. Citation Format: Shari B Goldfarb, Bridgette Thom, Cassandra Chang, Nadia Abdo, Andrea Carpio, Rosemary Semler, Catherine Benedict, Patricia Hershberger, Joanne F Kelvin, Mary L Gemignani. Decisions and outcomes of young women with breast cancer regarding fertility preservation before cancer treatment and family building after treatment [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-03.

Pregnancy Outcomes in Young Women With Youth-Onset Type2 Diabetes Followed in the TODAY Study.

To assess pregnancy outcomes in young women with youth-onset type 2 diabetes followed in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. Pregnancy information (outcome and any maternal or fetal complications) was obtained from the female participants by self-report. Additionally, medical records for the pregnancy and the child's neonatal course were obtained with data abstracted into standardized forms. Over a maximum of 15 years, 260 pregnancies were reported by 141 women (aged 21.5 ± 3.2 years, BMI 35.6 ± 7.2 kg/m2, and diabetes duration 8.1 ± 3.2 years). Contraception use prior to pregnancy was reported by 13.5% of the women. Complications were reported by 65% of the women during their pregnancy. Pregnancy loss was observed in 25.3% and preterm birth in 32.6% of pregnancies. HbA1c ≥8% was observed in 31.9% of the pregnancies, and 35% of the pregnancies were complicated by chronic hypertension. Nephropathy prior to pregnancy was observed in 25% of the women. In the offspring, 7.8% were classified as small for gestational age, 26.8% large for gestational age, and 17.9% in the macrosomic range. Based on observations from the TODAY cohort, young women with pregestational, youth-onset type 2 diabetes had very high rates of maternal complications stemming from significant socioeconomic disadvantage. The substantial maternal and infant complications seen in these young moms could potentially be avoided with improved contraception rates and reproductive planning.

Long-term post-recurrence survival outcomes in young women receiving fertility-sparing surgery for epithelial ovarian cancer

ObjectiveThe aim of this study was to investigate long-term post-recurrence survival outcomes in young women receiving fertility-sparing surgery (FSS) to verify the feasibility of the limited surgery for epithelial ovarian cancer (OvCa). Study designWe performed a regional multicenter retrospective study from January 1986 and March 2020, using clinical data corrected under the central pathological review system. Patients with recurrent tumor after surgery for stage I epithelial OvCa, aged equal or younger than 45 years were included for this study. We evaluated effect of FSS regarding long-term post-recurrence survival with statistical adjustment of propensity score-based method. ResultsWith the Kaplan–Meier method, original and adjusted survival curves were estimated for recurrence-after survival of patients with (n = 14) and without FSS (n = 26). Median time to disease-specific death was 18.6 months. In both original and adjusted cohorts, there were no significant difference between the two groups (log rank test; P > 0.05). Hazard ratio of disease-specific death was 1.264 (95% confidence interval, 0.563–2.836; P = 0.570) in original and 1.354 (95% confidence interval, 0.702–2.611; P = 0.366) in adjusted population. This result indicated that patients with FSS was not associated with poorer prognosis for recurrence-after survival than those without. When comparing patients not receiving FSS, patients receiving FSS with recurrence at spared ovary followed not significantly different survival outcome as well as those with extra-ovarian recurrence. ConclusionThere was no significant difference of long-term post-recurrence survival outcomes between patients of epithelial OvCa with and without FSS in young women of reproductive age.

Abstract 13866: Quantity of Cardiovascular Risk Factors and Associated Outcomes in Young Women With ST-Elevation Myocardial Infarction

Introduction: Despite the remarkable progress in STEMI care, the mortality rates in young women with STEMI remain high. It remains unclear whether this is related to the number of cardiovascular (CV) risk factors. Methods: From 2010 to 2020, we evaluated 10,441 consecutive STEMI patients, including 3,150 (30%) women enrolled in prospective Midwest STEMI Consortium registry, constituted of Minneapolis Heart Institute, Minneapolis, MN, The Christ Hospital, Cincinnati, OH, Prairie Heart Institute, Springfield, IL, and Iowa Heart Center, Des Moines, IA. We categorized baseline CV risk factors (hypertension, dyslipidemia, diabetes, smoking, and family history of CAD) in the 477 (15%) women &lt;55 years and without previous history of CAD. Results: Smoking was the most common, and diabetes the least common CV risk factor. Of the 477 women, 161 (33.8%) had 0 or 1 CV risk factor, 132 (27.7%) had 2, and 184 (38.6%) had at least 3 CV risk factors. As the number of CV risk factors decreased, non-atherosclerotic STEMI etiologies -SCAD or Takotsubo syndrome- increased, as did the incidences of cardiogenic shock or cardiac arrest. There were no differences in reperfusion strategies or time among patients with 0 or more CV risk factors; however, as the number of CV risk factors decreased, patients were less likely to receive antiplatelet or statin at discharge. There was a trend toward higher death in the hospital with decreasing number of CV risk factors, but it did not reach statistical significance (p=0.075) (Table). Conclusions: Young women with fewer traditional CV risk factors more often presented with non-atherosclerotic causes of STEMI and higher incidences of cardiogenic shock or cardiac arrest and had a trend toward a higher risk of in-hospital death. Thus, future epidemiological studies are needed to determine if sex-specific risk enhancers, in addition to traditional CV risk factors, have a role in risk stratification among young women for future CV events.

Long-term health outcomes in young women with polycystic ovary syndrome: A narrative review.

Polycystic ovary syndrome (PCOS) has long been recognized as a common disorder in young women leading to reproductive and cutaneous sequelae. However, the associated health risks are now known to extend beyond these familiar manifestations to a range of longer-term comorbidities. Here we review the evidence for an association of PCOS with adverse long-term health outcomes, discussing the pathophysiological mechanisms involved in addition to opportunities for therapeutic intervention. Cross-sectional and longitudinal studies point to an increased risk of type 2 diabetes, hypertension and dyslipidaemia, with recent data confirming that these translate to an increased risk of cardiovascular events independently of obesity. Obstructive sleep apnoea, nonalcoholic fatty liver disease and endometrial cancer are also more prevalent, while mental health disorders, notably anxiety and depression, are common but under-appreciated associations. Uncertainties remain as to whether these risks are apparent in all patients with PCOS or are confined to particular subtypes, whether risks persist post-menopausally and how risk may be affected by ethnicity. Further work is also needed in establishing if systematic screening and targeted intervention can lead to improved outcomes. Until such data are available, clinicians managing women with PCOS should counsel patients on long-term health risks and invest in strategies that limit progression to metabolic and non-metabolic morbidities.