Web-Based Survey of Fertility Issues in Young Women With Breast Cancer
Harvard University, Cambridge, Massachusetts, United States Journal of Clinical Oncology
(Impact Factor: 18.43).
11/2004; 22(20):4174-83. DOI: 10.1200/JCO.2004.01.159
Young women with breast cancer often seek advice about whether treatment will affect their fertility. We sought to gain a better understanding of women's attitudes about fertility and how these concerns affect decision making.
We developed a survey about fertility issues for young women with a history of early-stage breast cancer. The survey was e-mailed to all registered Young Survival Coalition survivor members (N = 1,702). E-mail reminders were used.
Six hundred fifty-seven eligible respondents completed the survey. Mean age at breast cancer diagnosis was 32.9 years; mean current age was 35.8 years. Ninety percent of women were white; 62% were married; 76% were college graduates. Stages at diagnosis were as follows: 0, 10%; I, 27%; II, 47%; III, 13%. Sixty-two percent of women were within 2 years of diagnosis. Fifty-seven percent recalled substantial concern at diagnosis about becoming infertile with treatment. In multivariate logistic regression, greater concern about infertility was associated with wish for children/more children (odds ratio [OR], 120; P < .0001), number of prior pregnancies (OR, 0.78; P = .01), and prior difficulty conceiving (OR, 1.86; P = .08). Twenty-nine percent of women reported that infertility concerns influenced treatment decisions. Seventy-two percent of women reported discussing fertility concerns with their doctors; 51% felt their concerns were addressed adequately. Women seemed to overestimate their risk of becoming postmenopausal with treatment.
Fertility after treatment is a major concern for young women with breast cancer. There is a need to communicate with and educate young patients regarding fertility issues at diagnosis and a need for future research directed at preserving fertility for young breast cancer survivors.
Available from: Wan Tinn Teh
- "As cancer treatments improve, optimising quality of life in cancer survivors is of growing significance. Loss of fertility is a key issue for younger cancer survivors  . Irradiation of the ovaries will induce ovarian failure in almost 90% of women, as observed in childhood abdominal radiation . "
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ABSTRACT: Future fertility is of paramount importance to younger cancer survivors. Advances in assisted reproductive technology mean that young women treated with radiation involving the uterus may require clinical guidance regarding whether to attempt a pregnancy themselves. We performed a review of the literature regarding radiation involving uterus (total body irradiation (TBI) and pelvic radiation), fertility, and pregnancy outcomes to come up with a recommendation for our patients. Limited evidence suggests lower fecundity and an increased incidence of pregnancy complications after uterine radiation. Higher radiation doses and direct uterine radiation both significantly increase the risk of an adverse pregnancy outcome. Uterine radiation doses of <4 Gy do not appear to impair uterine function. Adult TBI data (usually 12 Gy) suggest pregnancy is possible but with lower fecundity and more complications. Although there is no clear data indicating the dose of radiation to the uterus, above which a pregnancy would not be sustainable, we suggest patients receiving >45 Gy during adulthood and >25 Gy in childhood be counselled to avoid attempting pregnancy. There is preliminary evidence that menopausal hormone therapy and a combination of pentoxifylline and tocopherol may improve uterine function following irradiation.
BioMed Research International 08/2014; 2014:482968. DOI:10.1155/2014/482968 · 1.58 Impact Factor
Available from: Vikki Knott
- "A further important survivorship issue amongst breast cancer patients is the prospect of reduced fertility after treatment. Most breast cancer treatments have some effect on fertility (Kasum et al. 2014) and several studies have demonstrated that fertility preservation is a significant issue, particularly for young women (Partridge et al. 2004) who also experience considerable psychosocial concerns (Baucom et al. 2005). Typically concerns regarding fertility are shared by women and their partners – fertility is understandably a significant concern for women undergoing treatment for cancer. "
European Journal of Cancer Care 07/2014; 23(4):423-5. DOI:10.1111/ecc.12212 · 1.56 Impact Factor
Available from: Vânia Goncalves
- "In clinical practice, gynaecologists and oncologists are frequently faced with the issue of educating women about childbearing options after breast cancer. However, some studies suggest that these professionals often feel discomfort and a lack of knowledge about how best to educate women with cancer-related fertility matters (Duffy and Allen, 2009), leaving women's fertility concerns poorly addressed (Partridge et al., 2004). One reason is that providers may perceive the importance of fertility as low compared with treating the cancer (Vadaparampil et al., 2008). "
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Young breast cancer survivors often need to deal with adverse effects of treatments on fertility and complex reproductive decisions. In this systematic review, we highlight what is known about childbearing and parenthood attitudes and decisions of young breast cancer survivors from their own perspective.METHODS
We conducted manual and electronic searches on Pubmed, PsychInf and CINAHL databases for articles, published in English between 1 January 1990 and 31 October 2012, that assessed childbearing, pregnancy and parenthood attitudes/decisions of female breast cancer survivors (premenopausal and/or <50 years old). Eligible articles were classified into quantitative studies, qualitative studies and mixed methods studies. Data from each study were individually extracted by all the authors, and standardized tables were created and discussed to ensure congruence of the information extracted.RESULTSOf the 493 publications identified in PubMed (results are presented for PubMed searches as the other databases did not yield any new relevant papers), 8 met the inclusion criteria, in addition to 2 publications retrieved manually. A total of 10 studies provided information on pregnancy and parenthood attitudes and decisions, in addition to risks and benefits of childbearing after breast cancer. Survivors had mixed attitudes towards the issue. Fear associated with future pregnancy was reported, namely the risk of cancer recurrence. However, for many survivors, pregnancy and parenthood can represent normalcy, happiness and life fulfilment.CONCLUSIONS
Childbearing after breast cancer is an important issue for survivors. Future larger and prospective studies should be implemented to increase certainty of conclusions of current research. Clinicians may benefit from a deeper understanding of the importance of pregnancy and parenthood to survivors in order to provide the needed educational and psychosocial support services, overcome misinformation and better assist women with their fertility-related decisions.
Human Reproduction Update 09/2013; 20(2). DOI:10.1093/humupd/dmt039 · 10.17 Impact Factor
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