Leah Hawkins Bressler1, Jennifer E Mersereau1, Chelsea Anderson2, Juan L Rodriguez3, M Elizabeth Hodgson4, Clarice R Weinberg5, Dale P Sandler6, Hazel B Nichols2. 1. Division of Reproductive Epidemiology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 2. Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 3. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia. 4. Social and Scientific Systems, Raleigh-Durham, North Carolina. 5. Biostatistics and Computational Biology Branch, National Institute of Environmental Health Services, Research Triangle Park, North Carolina. 6. Epidemiology Branch, National Institute of Environmental Health Services, Research Triangle Park, North Carolina.
Abstract
BACKGROUND: Commonly used chemotherapies can be toxic to the ovaries. To the authors' knowledge, the majority of studies evaluating receipt of fertility counseling for women in their reproductive years have been performed in specific settings, thereby limiting generalizability. METHODS: A nationwide sample of US women diagnosed with breast cancer before age 45 years completed a survey assessing the prevalence of fertility counseling. Age-adjusted log-binomial regression was used to estimate prevalence ratios (PRs) and 95% CIs for fertility counseling. RESULTS: Among 432 survivors diagnosed between 2004 and 2011, 288 (67%) had not discussed the effects of treatment on fertility with a health care provider before or during treatment. Fertility discussion was associated with younger age (PR, 3.49 [95% CI, 2.66-4.58] for aged <35 years vs ≥40 years) and lower parity (PR, 1.81 [95% CI, 1.29-2.53] for parity 1 vs 2). Approximately 20% of respondents reported that they were interested in future fertility (87 of 432 respondents) at the time of their diagnosis, but not all of these individuals (66 of 87 respondents) received counseling regarding the impact of treatment on their fertility, and few (8 of 87 respondents) used fertility preservation strategies. Among 68 women with a fertility interest who provided reasons for not taking steps to preserve fertility, reasons cited included concern for an adverse impact on cancer treatment (56%), lack of knowledge (26%), decision to not have a child (24%), and cost (18%). CONCLUSIONS: Across multiple treatment settings, the majority of women of reproductive age who are diagnosed with breast cancer did not discuss fertility with a health care provider or use fertility preservation strategies. Discussing the potential impact of cancer treatment on future fertility is an important aspect of patient education.
BACKGROUND: Commonly used chemotherapies can be toxic to the ovaries. To the authors' knowledge, the majority of studies evaluating receipt of fertility counseling for women in their reproductive years have been performed in specific settings, thereby limiting generalizability. METHODS: A nationwide sample of US women diagnosed with breast cancer before age 45 years completed a survey assessing the prevalence of fertility counseling. Age-adjusted log-binomial regression was used to estimate prevalence ratios (PRs) and 95% CIs for fertility counseling. RESULTS: Among 432 survivors diagnosed between 2004 and 2011, 288 (67%) had not discussed the effects of treatment on fertility with a health care provider before or during treatment. Fertility discussion was associated with younger age (PR, 3.49 [95% CI, 2.66-4.58] for aged <35 years vs ≥40 years) and lower parity (PR, 1.81 [95% CI, 1.29-2.53] for parity 1 vs 2). Approximately 20% of respondents reported that they were interested in future fertility (87 of 432 respondents) at the time of their diagnosis, but not all of these individuals (66 of 87 respondents) received counseling regarding the impact of treatment on their fertility, and few (8 of 87 respondents) used fertility preservation strategies. Among 68 women with a fertility interest who provided reasons for not taking steps to preserve fertility, reasons cited included concern for an adverse impact on cancer treatment (56%), lack of knowledge (26%), decision to not have a child (24%), and cost (18%). CONCLUSIONS: Across multiple treatment settings, the majority of women of reproductive age who are diagnosed with breast cancer did not discuss fertility with a health care provider or use fertility preservation strategies. Discussing the potential impact of cancer treatment on future fertility is an important aspect of patient education.
Authors: Natasha D Buchanan; Sabitha Dasari; Juan L Rodriguez; Judith Lee Smith; M Elizabeth Hodgson; Clarice R Weinberg; Dale P Sandler Journal: Am J Prev Med Date: 2015-12 Impact factor: 5.043
Authors: Molly B Moravek; Rafael Confino; Kristin N Smith; Ralph R Kazer; Susan C Klock; Angela K Lawson; William J Gradishar; Mary Ellen Pavone Journal: Fertil Steril Date: 2018-01-17 Impact factor: 7.329
Authors: Leslie V Farland; Judy E Stern; Sunah S Hwang; Chia-Ling Liu; Howard Cabral; Richard Knowlton; Susan T Gershman; Charles C Coddington; Stacey A Missmer Journal: J Assist Reprod Genet Date: 2022-01-17 Impact factor: 3.412