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
Source: PubMed


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.

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    • "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 [7] [8]. Irradiation of the ovaries will induce ovarian failure in almost 90% of women, as observed in childhood abdominal radiation [5]. "
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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.
    Full-text · Article · Aug 2014 · BioMed Research International
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    • "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. "

    Full-text · Article · Jul 2014 · European Journal of Cancer Care
    • "Such concerns have been reported by other studies as well (Schover,1994; Harmer, 2006). While loss of fertility is a common concern to young women with breast cancer (Thewes et al., 2003; Spencer et al., 1999; Partridge et al., 2004), single childless women may be particularly vulnerable to worries about future parenthood. There is some evidence, however, about better psychological outcomes of single women with breast cancer compared with those who are married, indicating that some married women tend to experience difficulties with their partnership and the help received (Pistrang and Barker, l995). "
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    ABSTRACT: Marital or partnership status is seldom investigated as a primary contributing factor to women's wellbeing after a diagnosis of breast cancer. It has been suggested, however, that single childless women with breast cancer may face unique stressors. This paper explores the stressors and vulnerabilities of young single childless women with a first episode of breast cancer. A qualitative descriptive method was used. As part of a larger study examining fertility concerns of young childless women with first episode of breast cancer, in-depth semi-structured interviews were conducted with 10 single women. Recorded interviews were analysed using the framework approach. Findings cover three main themes: partnership worries; fertility concerns; and views about emotional and practical support received. Partnership worries included concerns about having to undergo treatment without a partner to support them; the fear of rejection by potential partners; and feelings about the precious time lost in diagnosis and treatment. Fertility concerns included dilemmas about having children and feelings about the options of pursuing Assisted Reproductive Techniques. Views about the emotional and practical support received included the overall support received as well as perceptions about the attitudes of health professionals towards fertility issues. Findings indicate that single childless women with breast cancer face additional vulnerabilities and may benefit from tailored support from health care professionals and interventions specifically targeted at them.
    No preview · Article · Nov 2013 · European journal of oncology nursing: the official journal of European Oncology Nursing Society
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