Tesch Megan E, Sorouri Kimia, Zheng Yue, Rosenberg Shoshana M, Ruddy Kathryn J, Emmons Karen M, Dutton M Caryn, Partridge Ann H
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts; University of Alberta, Edmonton, Alberta, Canada.
Fertil Steril. 2025 Mar;123(3):488-498. doi: 10.1016/j.fertnstert.2024.09.024. Epub 2024 Sep 19.
To evaluate contraception use and change among young women with early breast cancer.
Secondary analysis of a cluster randomized trial.
Patients with newly diagnosed breast cancer age ≤45 years enrolled from 54 US oncology practices.
Sites were randomly assigned to the Young Women's Intervention, an educational intervention for young women with newly diagnosed breast cancer and their oncologists addressing issues specific to this population, including contraception, or a contact-time control physical activity intervention. Participants completed surveys in follow-up, including a 3-month survey regarding contraceptive practices before and after diagnosis.
Outcomes of interest included young women's contraceptive use and methods before breast cancer diagnosis and 3 months after study enrollment. Logistic regression models assessed factors associated with use of less than highly effective contraceptive methods categorized according to World Health Organization effectiveness tiers and changes in contraceptive methods.
Of 312 women included, 258 (83%) reported contraceptive use before breast cancer diagnosis, and 275 (88%) reported contraceptive use after diagnosis. Use of highly effective methods (e.g., vasectomy, non-hormonal intrauterine devices) increased from 39% before diagnosis to 52% after diagnosis. Use of moderately effective methods (e.g., hormonal methods) decreased from 22% before diagnosis to 3% after diagnosis. Use of less effective methods (e.g., condoms, withdrawal) increased from 22% before diagnosis to 34% after diagnosis. On multivariable analysis, factors associated with using less than highly effective contraception after diagnosis included desire for additional children (odds ratio [OR], 6.33; 95% confidence interval [CI], 3.76-10.66) and discussing contraception with a provider (OR, 1.96; 95% CI, 1.12-3.40). After breast cancer diagnosis, 207 patients (66%) reported no change in contraceptive methods. On multivariable analysis, factors associated with contraceptive method change after diagnosis included age <35 years (OR, 2.96; 95% CI, 1.57-5.58) and provider discussion (OR, 3.59; 95% CI, 1.91-6.78). There was no association in either analysis with study arm.
Although most patients used contraception after breast cancer diagnosis, nearly half reported using less than highly effective contraceptive methods with higher failure rates, highlighting the need for early and improved contraceptive counseling for young women with breast cancer.
NCT01647607.
评估早期乳腺癌年轻女性的避孕措施使用情况及变化。
一项整群随机试验的二次分析。
从美国54家肿瘤医疗实践机构招募的年龄≤45岁的新诊断乳腺癌患者。
各研究点被随机分配至“年轻女性干预组”，这是一项针对新诊断乳腺癌年轻女性及其肿瘤医生的教育干预措施，涉及该人群的特定问题，包括避孕，或接触时间控制的体育活动干预组。参与者在随访中完成调查，包括一项关于诊断前后避孕措施使用情况的3个月调查。
感兴趣的结果包括乳腺癌诊断前及研究入组后3个月年轻女性的避孕措施使用情况及方法。逻辑回归模型评估与使用低于世界卫生组织有效性分级的高效避孕方法相关的因素以及避孕方法的变化。
在纳入的312名女性中，258名（83%）报告在乳腺癌诊断前使用避孕措施，275名（88%）报告在诊断后使用避孕措施。高效方法（如输精管切除术、非激素宫内节育器）的使用从诊断前的39%增至诊断后的52%。中度有效方法（如激素方法）的使用从诊断前的22%降至诊断后的3%。低效方法（如避孕套、体外射精）的使用从诊断前的22%增至诊断后的34%。多变量分析显示，诊断后使用低于高效避孕措施的相关因素包括想要更多孩子（比值比[OR]，6.33；95%置信区间[CI]，3.76 - 10.66）以及与医疗服务提供者讨论避孕问题（OR，1.96；95% CI，1.12 - 3.40）。乳腺癌诊断后，207名患者（66%）报告避孕方法无变化。多变量分析显示，诊断后避孕方法改变的相关因素包括年龄<35岁（OR，2.96；95% CI，1.57 - 5.58）以及与医疗服务提供者讨论（OR，3.59；95% CI，1.91 - 6.78）。两项分析中均未发现与研究分组有关联。
尽管大多数患者在乳腺癌诊断后使用避孕措施，但近一半患者报告使用的是低于高效且失败率较高的避孕方法，这凸显了对乳腺癌年轻女性进行早期且更好的避孕咨询的必要性。
NCT01647607。
