Angelena Crown1, Shirin Muhsen2, Emily C Zabor3, Varadan Sevilimedu4, Joanne Kelvin5, Shari B Goldfarb6, Mary L Gemignani7. 1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 2. Clemenceau Medical Center, Johns Hopkins International, Beirut, Lebanon. 3. Department of Quantitative Health Sciences, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA. 4. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 5. Department of Medicine, Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 6. Breast Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 7. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. gemignam@mskcc.org.
Abstract
BACKGROUND: The American Society of Clinical Oncology guidelines recommend early referral to reproductive endocrinology and infertility (REI) specialists for young women diagnosed with breast cancer. Current practice patterns demonstrate an increased utilization of neoadjuvant chemotherapy (NAC). We evaluated premenopausal women with breast cancer after consultation with a Fertility Nurse Specialist (FNS) and determine factors associated with referral to REI specialists. METHODS: This retrospective review included all premenopausal women diagnosed at our institution with stage 0-III unilateral breast cancers between 2009 and 2015 who completed an FNS consultation. Clinicopathologic features and factors associated with referral to REI after FNS consultation were analyzed. RESULTS: A total of 334 women were identified. Median age was 35 years (interquartile range 32-38). The majority of women were single (n = 198, 59.3%) and nulliparous (n = 239, 71.6%). REI referrals were common (n = 237, 71.0%). The Breast Surgery service was the most frequent referring service (n = 194, 58.1%), with significantly more REI referrals compared to Breast Medicine and Genetics services (p = 0.002). Nulliparity was associated with REI referral (p < 0.0001). Adjuvant chemotherapy (p = 0.003) was associated with pursuing REI referral, whereas NAC (p < 0.001) was associated with declining REI referral. CONCLUSIONS: Most women elected to consult with an REI specialist, confirming strong interest in fertility preservation among premenopausal women with breast cancer. However, women receiving NAC more frequently declined referral to REI, suggesting that the need to start NAC may influence decisions regarding fertility preservation. With increasing utilization of NAC, our study supports the need for further counseling and education regarding fertility preservation for women undergoing NAC.
BACKGROUND: The American Society of Clinical Oncology guidelines recommend early referral to reproductive endocrinology and infertility (REI) specialists for young women diagnosed with breast cancer. Current practice patterns demonstrate an increased utilization of neoadjuvant chemotherapy (NAC). We evaluated premenopausal women with breast cancer after consultation with a Fertility Nurse Specialist (FNS) and determine factors associated with referral to REI specialists. METHODS: This retrospective review included all premenopausal women diagnosed at our institution with stage 0-III unilateral breast cancers between 2009 and 2015 who completed an FNS consultation. Clinicopathologic features and factors associated with referral to REI after FNS consultation were analyzed. RESULTS: A total of 334 women were identified. Median age was 35 years (interquartile range 32-38). The majority of women were single (n = 198, 59.3%) and nulliparous (n = 239, 71.6%). REI referrals were common (n = 237, 71.0%). The Breast Surgery service was the most frequent referring service (n = 194, 58.1%), with significantly more REI referrals compared to Breast Medicine and Genetics services (p = 0.002). Nulliparity was associated with REI referral (p < 0.0001). Adjuvant chemotherapy (p = 0.003) was associated with pursuing REI referral, whereas NAC (p < 0.001) was associated with declining REI referral. CONCLUSIONS: Most women elected to consult with an REI specialist, confirming strong interest in fertility preservation among premenopausal women with breast cancer. However, women receiving NAC more frequently declined referral to REI, suggesting that the need to start NAC may influence decisions regarding fertility preservation. With increasing utilization of NAC, our study supports the need for further counseling and education regarding fertility preservation for women undergoing NAC.
Authors: Anita Mamtani; Andrea V Barrio; Tari A King; Kimberly J Van Zee; George Plitas; Melissa Pilewskie; Mahmoud El-Tamer; Mary L Gemignani; Alexandra S Heerdt; Lisa M Sclafani; Virgilio Sacchini; Hiram S Cody; Sujata Patil; Monica Morrow Journal: Ann Surg Oncol Date: 2016-05-09 Impact factor: 5.344
Authors: Carlos A Puig; Tanya L Hoskin; Courtney N Day; Elizabeth B Habermann; Judy C Boughey Journal: Ann Surg Oncol Date: 2016-12-20 Impact factor: 5.344
Authors: Joseph M Letourneau; Nikita Sinha; Kaitlyn Wald; Eve Harris; Molly Quinn; Tal Imbar; Evelyn Mok-Lin; A Jo Chien; Mitchell Rosen Journal: Hum Reprod Date: 2017-10-01 Impact factor: 6.918
Authors: Brittany L Murphy; Courtney N Day; Tanya L Hoskin; Elizabeth B Habermann; Judy C Boughey Journal: Ann Surg Oncol Date: 2019-08-02 Impact factor: 5.344