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Fertility preservation tied to better reproductive outcomes after breast cancer

JAMA Oncology
Reuters Health - 01/12/2020 - Women with breast cancer who undergo fertility preservation are more likely than those who don't to have successful assisted reproductive technology (ART) treatments and live births, without added mortality risk, a recent study suggests.

Researchers examined data on 425 women diagnosed with breast cancer who underwent fertility preservation in Sweden between 1994 and 2017, as well as data on a cohort of 850 women matched by age, county, and time of breast cancer diagnosis who didn't undergo fertility preservation.

Women who received fertility preservation had higher live birth rates (adjusted hazard ratio 2.3) and higher rates of ART use (aHR 4.8) than women who didn't receive fertility preservation. All-cause mortality was also lower for the fertility preservation group (aHR 0.4).

"For a young woman newly diagnosed with breast cancer, the future chances to create a family are importantly diminished if she does not undergo fertility preservation," said senior study author Dr. Kenny Rodriguez-Wallberg, a reproductive medicine specialist at the Karolinska Institute in Stockholm, Sweden.

Fertility preservation can be safely achieved when young women diagnosed with cancer are promptly referred from oncologists to reproductive medicine specialists to ensure a timely discussion of fertility options and minimal delay of cancer treatment, Dr. Rodriguez-Wallberg said by email.

In the group that underwent fertility preservation, 97 women (22.8%) had at least one birth after their breast cancer diagnosis (mean follow-up 4.6 years), compared with 74 women (8.7%) in the cohort that didn't undergo fertility preservation (mean follow-up 4.8 years).

More women in the fertility group (71.1%) were nulliparous than in the cohort that didn't receive fertility preservation (20.1%). Women in the fertility preservation group were also more likely to have more than one child after breast cancer treatment (37.3%) than women who didn't receive fertility preservation (17.7%).

Women who underwent fertility preservation were younger (mean age 32.1 years) than those who did not (mean age 33.3 years). In addition, those who had fertility preservation were more likely to have estrogen-receptor positive tumors (68%) and to receive chemotherapy (93.9%) than those who didn't undergo fertility preservation (60.6% and 87.7%, respectively).

One important limitation of the study is that researchers lacked data on patients' preferences about having children, and it's possible women in the two groups differed in their intent to conceive, the study team notes in JAMA Oncology.

Even so, the results demonstrate the potential for women to benefit from fertility preservation if they do wish to have children after treatment, and underscore the importance of clinicians discussing this option with patients, said Dr. Kutluk Oktay, director of the Innovation Institute for Fertility Preservation and IVF in New York City, who wasn't involved in the study.

There are numerous ways women with breast cancer can safely preserve their fertility before chemotherapy, Dr. Oktay, who also directs the Laboratory of Molecular Reproduction and Fertility Preservation at Yale University School of Medicine in New Haven, Connecticut, said by email.

"We have developed specific ovarian stimulation protocols using aromatase inhibitors or tamoxifen treatments to block unwanted effects of rising estrogen onto breast cancer cells, so that women can safely preserve their oocytes and embryos," Dr. Oktay said. "In addition, women with breast cancer undergo ovarian freezing, which does not require ovarian stimulation."

SOURCE: https://bit.ly/3odVLAy JAMA Oncology, online November 19, 2020.

By Lisa Rapaport

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