Inequalities in Fertility-Impacting Cancer Incidence Among Young Populations in the United States.

INTRODUCTION

Infertility is a concerning late effect of cancer and cancer treatments, yet referrals for fertility preservation are unequal across U.S. sociodemographic groups. Although all-site cancer incidence varies across U.S. sociodemographic groups, it is unclear whether fertility-impacting cancers, specifically, are unevenly distributed by sex or race/ethnicity.

METHODS

Cross-sectional analysis of cancer registry data from the Surveillance, Epidemiology, and End Results (SEER) Program (2010-2020). Age-specific demographic rates and negative binomial regression with an exposure for population size were employed to assess inequalities in the incidence rates of fertility-impacting cancers among U.S. individuals aged 39 and younger. Wald tests were used to compare coefficients across the multivariable negative binomial regression models.

RESULTS

Women had higher incidence rates of fertility-impacting cancers (cancers of the reproductive organs, cancers in areas proximal to the reproductive organs or that contribute to reproductive functioning, and other cancers identified in the literature as fertility-impacting) in the fully adjusted models. These associations differed from the patterns observed among all other types of cancers. The incidence rates of fertility-impacting cancers also varied by race/ethnic groups. However, the patterning observed by race-ethnicity varied between the three fertility-impacting cancer groups.

CONCLUSION

The burden of fertility-impacting cancers is unequal across sex and race/ethnic groups. The sociodemographic patterns observed in fertility-impacting cancers differ substantively from cancers that were not identified as fertility-impacting. The findings reinforce the importance of screening for fertility-impacting cancers and identify a potential unmet need for both fertility preservation referrals among cancer patients and access to fertility treatment for survivors of cancer.