Preserving Fertility Delays Breast Cancer Treatment But Not Shorter Survival


06 Aug 2021

2 minutes to read

Disclosures: The authors do not report any relevant financial disclosures.

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Preservation of fertility after breast cancer diagnosis has led to short treatment times, according to the results of a retrospective cohort study published in Cancer.

However, the delays did not adversely affect the survival results.

Preservation of fertility after breast cancer diagnosis has led to short treatment times.
Data were derived from Greer AC, et al. Cancer. 2021; doi: 10.1002 / cncr.33601.

“Many young women with breast cancer undergo fertility preservation before cancer treatment”, Elizabeth S. Ginsburg, MD, researcher at the Center for Fertility and Reproductive Surgery and the Department of Obstetrics, Gynecology and Reproductive Biology at Brigham and Women’s Hospital, and colleagues wrote. “The most effective form of fertility preservation is the cryopreservation of embryos and / or oocytes after ovarian stimulation, resulting in supraphysiologic estradiol concentrations that could, in theory, stimulate estrogen-sensitive breast cancers. “

Ginsburg and colleagues examined the safety of ovarian stimulation for fertility preservation in 272 women aged 20 to 45 with newly diagnosed stage zero to stage III breast cancer. All the women participated in a fertility preservation consultation between 2005 and 2017, and 123 (45.2%) followed the process.

Women who underwent fertility preservation appeared to be more likely than those who did not undergo fertility preservation to be white (87.8% vs. 67.8%; P = .002) and have BRCA– positive disease (27.7% against 15.5%; P = .021).

The median follow-up was approximately 4 years.

Results showed that women who underwent fertility preservation experienced a longer delay to first treatment (37 days vs. 31 days; adjusted HR [aHR] = 0.74; 95% CI: 0.56-0.99) and a longer time to neoadjuvant chemotherapy (36 days versus 26 days; HRa = 0.41; 95% CI: 0.24-0.68) . They also experienced a longer delay between surgery and adjuvant treatment (41 days versus 33 days; HRa = 0.58; 95% CI: 0.38-0.9).

However, the groups had comparable adjusted invasive MSS rates at 3 years (85.4% vs. 79.4%) and 5 years (73.7% vs. 67.1%). In addition, the researchers observed no difference between the groups with fertility preservation and without OS preservation at 3 years (95.5% vs. 93.5%) or at 5 years (84.2% vs. 81 , 4%).

“Despite short delays in initiating treatment and high estrogen peaks, we found no statistically significant difference in recurrence or survival outcomes for women with breast cancer undergoing breast cancer preservation. fertility, which reinforces the findings of previous studies, ”the researchers wrote. “These results are consistent with those of a recently published Swedish registry-based cohort study that demonstrated a reduction in all-cause mortality in women exposed to fertility preservation compared to women who were not. not.

“An improved prognosis in women who have undergone fertility preservation has no biologically plausible cause,” added Ginsburg and colleagues. “However, this research reinforces hypotheses suggested by previous research for a ‘healthy fertility-preserving effect’, as women who choose to undergo a fertility reservation may be more likely to view their disease as transient compared to women. who choose not to undergo fertility preservation, who may view their disease as more permanent.

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