November 12, 2009
Fertility Procedures Need Not Delay Breast Cancer Treatment For Younger Women
Study in Journal of the American College of Surgeons finds fertility preservation is safe option
A new study published in the November issue of the Journal of the American College of Surgeons shows that breast cancer patients under 40 years old who undergo fertility preservation do not face a significant delay in the treatment of their disease when their care is coordinated in a timely fashion.
"Easy access and good communication among surgeons, medical oncologists and reproductive endocrinologists is critical," said Lynn Westphal, MD, associate professor, department of obstetrics and gynecology, Stanford University School of Medicine, Stanford, CA.
Frequently, young women who are diagnosed with breast cancer must make difficult decisions about surgical treatment options as well as chemotherapeutic treatments that may permanently impair their fertility or delay childbearing. Advancements in reproductive medicine such as in vitro fertilization have benefited young women with breast cancer.
"The burden of facing premature menopause adds to the stress experienced by young cancer survivors," said Irene Wapnir, MD, FACS, associate professor, department of surgery, Stanford University School of Medicine. "Fertility preservation through cryopreservation of eggs or fertilized oocytes may be an important measure to offset these concerns and promote emotional well-being. Our study shows that these procedures, when expedited and appropriately timed, do not delay cancer treatment."
Researchers used the Stanford Cancer Center tumor registry to retrospectively identify 82 women younger than 40 years old who received adjuvant chemotherapy for breast cancer. Of the women identified, 19 underwent ovarian stimulation and oocyte retrieval, and 63 did not. The timing of fertility preservation, surgical intervention and chemotherapy were compared with the time intervals between diagnosis and treatment in the patients who did not undergo fertility preservation.
The research team found that the median time from initial diagnosis to chemotherapy in women who underwent fertility preservation was 71 days (ranging from 45 days to 161 days) versus 67 days among those who did not (ranging from 27 days to 144 days; p<0.22). The median time interval from definitive operation to chemotherapy was similar in the two groups (p<0.79): 30 days for women undergoing fertility preservation (ranging from 14 days to 100 days) and 29 days for women in the control group (ranging from 12 days to 120 days). For women undergoing fertility preservation, the median time from initial diagnosis to a reproductive consultation was 30 days (ranging from 4 days to 133 days) and from referral to fertility preservation was 32 days (ranging from 13 days to 66 days).
The mean age of the women who underwent fertility preservation was 33.7 years, and 84.2 percent had not previously given birth. Among women who did not undergo fertility treatment, the mean age was 35.2 years, and 25.4 percent had not previously given birth. The two groups were dissimilar with respect to stage of disease: 47.3 percent of patients in the fertility preservation group had node-negative disease, compared with 25.4 percent in the control group. Furthermore, 73.7 percent of the fertility preservation group had estrogen-positive tumors, compared with 65.1 percent of the control group.
On the Net: