Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.
Faculty of Medicine, Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Hong Kong Med J. 2020 Jun;26(3):216-226. doi: 10.12809/hkmj198268. Epub 2020 May 28.
Cancer survivorship is increasingly important with advances in cancer therapeutics. Minimisation of treatment-related morbidity is an area that requires attention. This situation is most pressing in premenopausal patients with breast cancer, in whom advances in hormonal and targeted therapies have improved mortality rates. However, treatment-related infertility is still poorly addressed, and in East Asia, there is limited discussion regarding management of treatment-related infertility.
A search of the literature was conducted using PubMed, Google Scholar, and Science Direct using the terms "breast cancer", "fertility preservation", "oocyte and embryonic cryopreservation", "GnRH-a co-administration", "ovarian tissue cryopreservation and transplantation", "Japan", "China", "Korea", and 'Singapore". Only studies published in English from 1980-2019 were included. The focus of the review was on identifying the current fertility preservation methods available to premenopausal women with breast cancer and the barriers that impede access.
Fertility preservation options include GnRH-a co-administration to minimise treatment-associated infertility, oocyte and embryonic cryopreservation, and emerging treatments such as ovarian tissue cryopreservation and transplantation. In East Asia, the uptake of fertility preservation options has been limited despite it being a major patient concern. A lack of awareness of fertility preservation treatments hinders discussion between patients and clinicians about fertility preservation.
Despite progress in fertility preservation technologies, their impact for patients will be minimal if there is a lack of awareness/use of the technology. This review aims to raise awareness of such technologies among clinicians, enabling discussion between patients and clinicians about fertility preservation options.
随着癌症治疗方法的进步，癌症生存者越来越受到重视。减少与治疗相关的发病率是一个需要关注的领域。这种情况在乳腺癌的绝经前患者中最为紧迫，其中激素和靶向治疗的进步提高了死亡率。然而，与治疗相关的不孕问题仍未得到妥善解决，在东亚，关于治疗相关不孕的管理问题讨论有限。
使用 PubMed、Google Scholar 和 Science Direct 搜索文献，使用的术语为“乳腺癌”、“生育力保存”、“卵母细胞和胚胎冷冻保存”、“GnRH-a 联合应用”、“卵巢组织冷冻保存和移植”、“日本”、“中国”、“韩国”和“新加坡”。仅纳入 1980 年至 2019 年发表的英文研究。本综述的重点是确定目前可用于绝经前乳腺癌女性的生育力保存方法，以及阻碍其应用的障碍。
生育力保存的选择包括 GnRH-a 联合应用以最小化治疗相关不孕、卵母细胞和胚胎冷冻保存，以及新兴治疗方法如卵巢组织冷冻保存和移植。在东亚，尽管这是患者的主要关注点，但生育力保存选择的采用率一直受到限制。对生育力保存治疗的认识不足阻碍了患者与临床医生之间关于生育力保存的讨论。
尽管生育力保存技术取得了进展，但如果缺乏对该技术的认识/使用，对患者的影响将是微不足道的。本综述旨在提高临床医生对这些技术的认识，使患者与临床医生能够就生育力保存选择进行讨论。
