Kathryn J. Ruddy, Shari I. Gelber, Meghan E. Meyer, and Ann H. Partridge, Dana-Farber Cancer Institute; Rulla M. Tamimi and Elizabeth S. Ginsburg, Brigham and Women's Hospital; Lidia Schapira, Massachusetts General Hospital; Steven E. Come, Beth Israel Deaconess Medical Center, Boston, MA; and Virginia F. Borges, University of Colorado Denver, Aurora, CO.
J Clin Oncol. 2014 Apr 10;32(11):1151-6. doi: 10.1200/JCO.2013.52.8877. Epub 2014 Feb 24.
Most research regarding fertility in young women with breast cancer has focused on long-term survivors. Little is known about how fertility concerns affect treatment decisions or fertility preservation strategies at the time of initial cancer diagnosis.
As part of an ongoing prospective multicenter cohort study, we surveyed women with newly diagnosed early-stage breast cancer at age ≤ 40 years. The baseline survey included sociodemographic, medical, and treatment data as well as a modified Fertility Issues Survey, including fertility concern and preservation items. Univariable and multivariable modeling were used to investigate predictors of greater fertility concern.
Among the first 620 eligible respondents included in this analysis, median age was 37 years (range, 17 to 40 years); 425 women (68%) discussed fertility issues with their physicians before starting therapy, and 319 (51%) were concerned about becoming infertile after treatment. Because of concerns about fertility, four women (1%) chose not to receive chemotherapy, 12 (2%) chose one chemotherapy regimen over another, six (1%) considered not receiving endocrine therapy, 19 (3%) decided not to receive endocrine therapy, and 71 (11%) considered receiving endocrine therapy for < 5 years; 65 (10%) used fertility preservation strategies. Greater concern about fertility was associated with younger age, nonwhite race, not having children, and receipt of chemotherapy.
Many young women with newly diagnosed breast cancer have concerns about fertility, and for some, these substantially affect their treatment decisions. Only a minority of women currently pursue available fertility preservation strategies in this setting.
大多数关于年轻乳腺癌女性生育能力的研究都集中在长期生存者身上。关于生育问题如何影响初始癌症诊断时的治疗决策或生育保护策略，知之甚少。
作为一项正在进行的前瞻性多中心队列研究的一部分，我们对≤40 岁的新诊断为早期乳腺癌的女性进行了调查。基线调查包括社会人口统计学、医学和治疗数据以及改良的生育问题调查，包括生育问题和保护项目。采用单变量和多变量模型来研究生育问题的更大担忧的预测因素。
在本分析中纳入的 620 名符合条件的首位应答者中，中位年龄为 37 岁（范围 17 至 40 岁）；425 名女性（68%）在开始治疗前与医生讨论过生育问题，319 名女性（51%）担心治疗后会不孕。由于对生育能力的担忧，有 4 名女性（1%）选择不接受化疗，12 名女性（2%）选择了另一种化疗方案，6 名女性（1%）考虑不接受内分泌治疗，19 名女性（3%）决定不接受内分泌治疗，71 名女性（11%）考虑接受内分泌治疗<5 年；65 名女性（10%）使用了生育保护策略。对生育能力的更大担忧与年龄较小、非白种人、没有孩子和接受化疗有关。
许多新诊断为乳腺癌的年轻女性对生育能力感到担忧，对一些女性来说，这些担忧极大地影响了她们的治疗决策。在这种情况下，只有少数女性目前会选择现有的生育保护策略。
