Vuković Petra, Kasum Miro, Raguž Jelena, Lonjak Nikolina, Bilić Knežević Sara, Orešković Ivana, Beketić Orešković Lidija, Čehić Ermin
1Division of Radiotherapy and Medical Oncology, University Hospital for Tumors, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Obstetrics and Gynecology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Zadar General Hospital, Department of Oncology and Nuclear Medicine, Zadar, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Department of Clinical Oncology, School of Medicine, University of Zagreb, Zagreb, Croatia; 6Human Reproduction Unit, Zenica Cantonal Hospital, Zenica, Bosnia and Herzegovina.
Acta Clin Croat. 2019 Mar;58(1):147-156. doi: 10.20471/acc.2019.58.01.19.
Although breast cancer (BC) occurs more often in older women, it is the most commonly diagnosed malignancy in women of childbearing age. Owing to the overall advancement of modern medicine and the growing global trend of delaying childbirth until later age, we find ever more younger women diagnosed and treated for BC who have not yet completed their family. Therefore, fertility preservation has emerged as a very important quality of life issue for young BC survivors. This paper reviews currently available options for fertility preservation in young women with early-stage BC and highlights the importance of a multidisciplinary approach to fertility preservation as a very important quality of life issue for young BC survivors. Pregnancy after BC treatment is considered not to be associated with an increased risk of BC recurrence; therefore, it should not be discouraged for those women who want to achieve pregnancy after oncologic treatment. Currently, it is recommended to delay pregnancy for at least 2 years after BC diagnosis, when the risk of recurrence is highest. However, BC patients of reproductive age should be informed about the potential negative effects of oncologic therapy on fertility, as well as on the fertility preservation options available, and if interested in fertility preservation, they should be promptly referred to a reproductive specialist. Early referral to a reproductive specialist is an important factor that increases the likelihood of successful fertility preservation. Embryo and mature oocyte cryopreservation are currently the only established fertility preservation methods but they require ovarian stimulation (OS), which delays initiation of chemotherapy for at least 2 weeks. Controlled OS does not seem to increase the risk of BC recurrence. Other fertility preservation methods (ovarian tissue cryopreservation, cryopreservation of immature oocytes and ovarian suppression with gonadotropin-releasing hormone agonists) do not require OS but are still considered to be experimental techniques for fertility preservation.
尽管乳腺癌（BC）在老年女性中更为常见，但它却是育龄女性中最常被诊断出的恶性肿瘤。由于现代医学的整体进步以及全球范围内越来越多的女性将生育推迟至更高年龄，我们发现越来越多尚未完成生育的年轻女性被诊断出患有乳腺癌并接受治疗。因此，生育力保存已成为年轻乳腺癌幸存者一个非常重要的生活质量问题。本文回顾了目前针对早期乳腺癌年轻女性的生育力保存可用选项，并强调了多学科方法对于生育力保存的重要性，这是年轻乳腺癌幸存者一个非常重要的生活质量问题。乳腺癌治疗后的妊娠被认为与乳腺癌复发风险增加无关；因此，对于那些希望在肿瘤治疗后怀孕的女性，不应加以劝阻。目前，建议在乳腺癌诊断后至少推迟2年怀孕，此时复发风险最高。然而，应该告知育龄期乳腺癌患者肿瘤治疗对生育力的潜在负面影响以及可用的生育力保存选项，如果她们对生育力保存感兴趣，应及时转诊至生殖专家处。早期转诊至生殖专家是提高生育力保存成功率的一个重要因素。胚胎和成熟卵母细胞冷冻保存目前是仅有的已确立的生育力保存方法，但它们需要卵巢刺激（OS），这会使化疗开始时间至少推迟2周。控制性卵巢刺激似乎不会增加乳腺癌复发风险。其他生育力保存方法（卵巢组织冷冻保存、未成熟卵母细胞冷冻保存以及使用促性腺激素释放激素激动剂进行卵巢抑制）不需要卵巢刺激，但仍被视为生育力保存的实验技术。
