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Does Use of Neoadjuvant Chemotherapy Affect the Decision to Pursue Fertility Preservation Options in Young Women with Breast Cancer?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Acknowledgment

This study was accepted for presentation in poster format at the 21st Annual Meeting of the American Society of Breast Surgeons, April 29–May 3, 2020, Las Vegas, NV.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Angelena Crown MD & Mary L. Gemignani MD, MPH

  2. Clemenceau Medical Center, Johns Hopkins International, Beirut, Lebanon

    Shirin Muhsen MD

  3. Department of Quantitative Health Sciences, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

    Emily C. Zabor DrPH

  4. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Varadan Sevilimedu DrPH

  5. Department of Medicine, Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Joanne Kelvin RN

  6. Breast Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Shari B. Goldfarb MD

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  1. Angelena Crown MD
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  2. Shirin Muhsen MD
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  3. Emily C. Zabor DrPH
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Correspondence to Mary L. Gemignani MD, MPH.

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Disclosure

The preparation of this manuscript was funded in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center. Dr. Shari B. Goldfarb discloses research funding from Sprout Pharmaceuticals and Paxman Coolers Ltd, and consulting and advisory roles to Sermonix Pharmaceuticals, Bayer Healthcare, and Procter and Gamble. All other authors have no conflicts of interest to disclose.

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Crown, A., Muhsen, S., Zabor, E.C. et al. Does Use of Neoadjuvant Chemotherapy Affect the Decision to Pursue Fertility Preservation Options in Young Women with Breast Cancer?. Ann Surg Oncol 27, 4740–4749 (2020). https://doi.org/10.1245/s10434-020-08883-y

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  • DOI: https://doi.org/10.1245/s10434-020-08883-y

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