Fertility Preservation Delays Breast Cancer Treatment But Doesn’t Affect Survival

Many young women face a dilemma after a breast cancer diagnosis: should they take the time to opt for fertility preservation (FP) in case they want to have a baby later, or should they proceed directly onto treatment?

A team of researchers set out to examine the safety implications of fertility preservation, which involves ovarian stimulation, among young women with estrogen receptor-positive (ER+) or -negative (ER-) breast cancer. The results were published in Cancer.

The researchers conducted a retrospective cohort study of 272 women between the ages of 20 and 45 with newly diagnosed breast cancer (stages 0 through III) who went through an FP consultation between 2007 and 2017. Of the 272 women whose data they analyzed, 123 chose to undergo FP and 149 chose not to undergo FP.

The analysis showed that embarking upon FP did delay the initiation of systemic treatment, but the delay did not affect recurrence or survival.

The median times to treatment were faster for the women who did not undergo FP; they began their initial treatment 6 days sooner than the women who chose the FP route. The women who opted out of FP also began neoadjuvant chemotherapy 10 days sooner and adjuvant chemotherapy 8 days sooner after surgery.

They examined invasive-disease free survival (IDFS) at 3 and 5 years after diagnosis for the 2 groups and found that 3-year IDFS rate was 85.4% for those who underwent FP and 79.4% for those who did not (P =.411) and 5-year IDFS rates were 73.7% and 63.1%, respectively (P =.288). Plus, there was no difference in overall survival rates at 3 years for the 2 groups of patients (95.5% for those with FP and 93.5% for those with no FP [P =.854]).

“Despite short delays in treatment initiation and peak estrogen levels, we found no statistically significant difference in recurrence or survival outcomes for women with breast cancer undergoing FP, and this bolsters the findings of prior studies,” the researchers wrote.

Use of controlled ovarian stimulation for the purpose of FP is a safe option for women with breast cancer facing gonadotoxic treatment regimens who wish to preserve their future fertility.

The researchers did note that the nonrandomized and retrospective nature of the study were limitations. Plus, this was a single institution study with a relatively small sample size. And with only a 50-month follow-up period, cancer recurrence may have occurred later on, after the study concluded.

“But the lack of demonstrable harm from FP for breast cancer clinical outcomes even in a complex patient population should serve as reassurance to patients and providers alike,” they wrote.

The information gleaned from this research could be used by clinicians during patient counseling sessions to educate young women with breast cancer about their options and could decrease fears for those who do opt to pursue FP.

Reference

Greer AC, Lanes A, Poorvu P, et al. The impact on fertility preservation on the timing of breast cancer treatment, recurrence, and survival. Cancer. June 23, 2021. doi:10.1002/cncr.33601