1 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Queen's University, Kingston, Canada.
2 Division of Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver, Canada.
J Adolesc Young Adult Oncol. 2019 Apr;8(2):197-204. doi: 10.1089/jayao.2018.0102. Epub 2019 Jan 24.
To assess the fertility preservation (FP) referral rates and patterns of newly diagnosed breast cancer in female adolescent and young adult (AYA) patients.
Women aged 15-39 years with newly diagnosed breast cancer in Ontario from 2000 to 2017 were identified using the Ontario Cancer Registry. Exclusion criteria included prior sterilizing procedure, health insurance ineligibility, and prior infertility or cancer diagnosis. Women with a gynecology consult between cancer diagnosis and chemotherapy commencement with the billed infertility diagnostic code (ICD-9 628) were used as a surrogate for FP referral. The effect of age, parity, year of cancer diagnosis, staging, income, region, neighborhood marginalization, and rurality on referral status was investigated.
A total of 4452 patients aged 15-39 with newly diagnosed breast cancer met the inclusion criteria. Of these women, 178 (4.0%) were referred to a gynecologist with a billing code of infertility between cancer diagnosis and initiation of chemotherapy. Older patients, prior parity, and advanced disease were inversely correlated with referrals. Referral rates also varied regionally: patients treated in the south-east and south-west Local Health Integration Networks (LHINs) had the highest probability of referral, and patients covered by north LHINs had the lowest (central LHIN as reference). General surgeons accounted for 36.5% of all referrals, the highest percentage of all specialists. Referral rates significantly increased over time from 0.4% in 2000 to 10.7% in 2016.
FP referral rates remain low and continue to be influenced by patient demographics and prognosis. These findings highlight the need for further interdisciplinary coordination in addressing the fertility concerns of AYA with newly diagnosed breast cancers.
评估新诊断为乳腺癌的女性青少年和年轻成人（AYA）患者的生育力保存（FP）转诊率和模式。
使用安大略省癌症登记处，确定了 2000 年至 2017 年期间安大略省新诊断为乳腺癌的 15-39 岁女性。排除标准包括先前的绝育手术、不符合健康保险资格以及先前的不孕或癌症诊断。在癌症诊断和化疗开始之间有妇科咨询，并开具不孕症诊断代码（ICD-9 628）的女性被用作 FP 转诊的替代指标。研究了年龄、产次、癌症诊断年份、分期、收入、地区、邻里边缘化和农村地区对转诊状况的影响。
共有 4452 名年龄在 15-39 岁的新诊断为乳腺癌的患者符合纳入标准。在这些女性中，有 178 人（4.0%）在癌症诊断和开始化疗之间被转诊给妇科医生，开具了不孕症计费代码。年龄较大、先前产次和晚期疾病与转诊呈负相关。转诊率在地区上也存在差异：在东南部和西南部地方卫生集成网络（LHIN）治疗的患者转诊的可能性最高，而在北部 LHIN 覆盖的患者转诊的可能性最低（以中部 LHIN 为参照）。普通外科医生占所有转诊的 36.5%，是所有专科医生中比例最高的。转诊率随着时间的推移显著增加，从 2000 年的 0.4%增加到 2016 年的 10.7%。
FP 转诊率仍然较低，并且继续受到患者人口统计学和预后的影响。这些发现强调了需要进一步的跨学科协调，以解决新诊断为乳腺癌的 AYA 的生育问题。
