The Unique Reproductive Concerns of Young Women with Breast Cancer

Dana-Farber Cancer Institute, Boston, MA 02215, USA.
Advances in Experimental Medicine and Biology (Impact Factor: 1.96). 01/2012; 732:77-87. DOI: 10.1007/978-94-007-2492-1_6
Source: PubMed


I am a 35 year old woman whose boyfriend found a mass in my breast two months ago. A biopsy showed it was breast cancer, and I was ultimately recommended to undergo chemotherapy and tamoxifen in addition to surgery. I told them I would very much like to be able to have children in the future, so my oncologist said I should consider embryo cryopreservation, as my likelihood of being able to conceive naturally after chemotherapy and at age 40, when the tamoxifen was finished, would not be high. However, she acknowledged that no one is sure whether ovarian stimulation prior to treatment, especially when my cancer was hormone sensitive, is safe. I met with a reproductive endocrinologist later that week, and we went over the pros and cons of fertility preservation options. My boyfriend I discussed it and we decided to move forward with embryo cryopreservation. Because my period had recently finished, I started ovarian stimulation quickly and had eggs harvested, fertilized with my boyfriend's sperm, and frozen less than two weeks later. I started chemotherapy the next day. While I realize there is uncertainty about the safety of pregnancy after breast cancer, knowing that I have taken steps to preserve my fertility is very reassuring to me as I begin my treatment. Diana, Breast Cancer Survivor

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    ABSTRACT: Assess fertility preservation (FP) measures chosen by patients newly diagnosed with malignancy and their outcomes. Reproductive-age patients referred for FP underwent counseling and elected cryopreservation vs. no treatment. Outcome measures included ovarian stimulation, FP choice, oocytes/zygotes retrieved/cryopreserved and pregnancy outcome. From 2005 to 2012, 136 patients were counseled with 124 electing treatment: 83 oocyte-only, 21 oocyte + zygote and 20 zygote-only cryopreservation. Age, partnership and financial status factored into FP choice. Treatment was completed in 12 ± 2 days with 14 ± 11 metaphase-II oocytes harvested and cryopreserved/cycle. Eight patients returned to attempt pregnancy; three succeeded. Our data demonstrate that oocyte and/or zygote banking are feasible FP options for women with malignancy; given the choice, the majority elected oocyte cryopreservation, highlighting desire for reproductive autonomy. Continued growth and research, combined with interdisciplinary communication, will ensure that appropriate candidates are offered FP and the potential for future parenthood, an important quality-of-life marker for survivors.
    Full-text · Article · Aug 2013 · Journal of Assisted Reproduction and Genetics
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    ABSTRACT: Background: Standard treatments for breast cancer can impair fertility. It is unknown how many U.S. survivors are at risk for infertility. We estimated the population at risk for infertility secondary to treatment among reproductive-aged breast cancer survivors. Methods: We combined data from three sources: the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results cancer registry data on incident breast cancers diagnosed in women aged 15-44 years between 2004 and 2006; treatment data from NPCR's 2004 Breast and Prostate Cancer Data Quality and Patterns of Care (PoC) study; and data on women's intentions to have children from the 2006-2010 National Survey of Family Growth (NSFG). Results: In the cancer registry data, an average of 20,308 women with breast cancer aged <45 years were diagnosed annually. Based on estimates from PoC data, almost all of these survivors (97%, 19,416 women) were hormone receptor positive or received chemotherapy and would be at risk for infertility. These women need information about the impact of treatments on fertility. Estimates based on NSFG data suggest approximately half of these survivors (9,569 women) might want children and could benefit from fertility counseling and fertility preservation. Conclusion: Nearly all young breast cancer survivors in the U.S. are at risk for infertility. Physicians should discuss the potential impact of treatment on fertility. A smaller but sizeable number of at-risk survivors may be interested in having children. Given the magnitude of potential infertility and its quality-of-life implications, these survivors should have access to and potential coverage for fertility services.
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    ABSTRACT: Introduction: Breast cancer in women aged 18-44 years accounts for approximately 27,000 newly diagnosed cases and 3,000 deaths annually. When tumors are diagnosed, they are usually aggressive, resulting in expensive treatment costs. The purpose of this study is to estimate the prevalent medical costs attributable to breast cancer treatment among privately insured younger women. Methods: Data from the 2006 MarketScan (R) database representing claims for privately insured younger women were used. Costs for younger breast cancer patients were compared with a matched sample of younger women without breast cancer, overall and for an active treatment subsample. Analyses were conducted in 2013 with medical care costs expressed in 2012 U.S. dollars. Results: Younger women with breast cancer incurred an estimated $19,435 (SE = $415) in additional direct medical care costs per person per year compared with younger women without breast cancer. Outpatient expenditures comprised 94% of the total estimated costs ($18,344 [SE = $396]). Inpatient costs were $43 (SE = $10) higher and prescription drug costs were $1,048 (SE = $64) higher for younger women with breast cancer than in younger women without breast cancer. For women in active treatment, the burden was more than twice as high ($52,542 [SE = $977]). Conclusions: These estimates suggest that breast cancer is a costly illness to treat among younger, privately insured women. This underscores the potential financial vulnerability of women in this age group and the importance of health insurance during this time in life.
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