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Predictors and outcomes in breast cancer patients who did or did not pursue fertility preservation

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Abstract

Purpose

Breast cancer is the most common cancer in reproductive age women, and treatment can affect fertility; however, there is often concern regarding the safety of increased estradiol (E2) levels and potential delays in treatment with ovarian stimulation for fertility preservation (FP). The aim of this study was to compare recurrence and survival in breast cancer patients who pursued FP without concurrent letrozole to those who did not (non-FP).

Methods

We reviewed charts of women with breast cancer who contacted the FP patient navigator (PN) at Northwestern University from 01/2005–01/2018. Oncology and fertility outcome data were collected. Data were analyzed by Chi-square test or regression, as appropriate. Kaplan–Meier curves were used to examine breast cancer recurrence and survival. Statistical analyses were performed with SPSS IBM Statistics 26.0 for Windows.

Results

332 patients were included, of which 157 (47.3%) underwent FP. Median days to treatment after consulting the PN was 35 in the FP group and 21 in non-FP (p < 0.05). Cancer recurrence was noted in 7 (4.7%) FP patients and 13 (7.9%) non-FP patients (NS), and mortality in 5 (3.2%) FP patients and 7 (4.2%) non-FP patients (NS). Within the FP group, no significant differences were found in recurrence or mortality based on ER status, age, BMI, peak E2 level or total gonadotropin dose. Likelihood of pursuing FP was primarily a function of age and parity, and was not affected by breast cancer stage. To date, 21 have used cryopreserved specimens, and 13 (62%) had a live birth.

Conclusions

FP is safe and effective in breast cancer patients, regardless of receptor status; E2 elevations and the 2-week delay in treatment start are unlikely to be clinically significant. These findings are unique in that our institution does not use concomitant letrozole during stimulation to minimize E2 elevations in breast cancer patients.

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Acknowledgements

The authors wish to thank all faculty, nurses, and staff at Northwestern Fertility and Reproductive Medicine for the excellent care they provide patients.

Funding

This study was funded by the National Institutes of Health and Northwestern Memorial Foundation Evergreen Grant (to MEP) and P50 HD076188 (MEP, PI: T. Woodruff).

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, MI, 48109, USA

    Molly B. Moravek

  2. Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA

    Rafael Confino, Angela K. Lawson, Kristin N. Smith, Ralph R. Kazer, Susan C. Klock & Mary Ellen Pavone

  3. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA

    William J. Gradishar

  4. Department of Surgery, University of Michigan Health System, Ann Arbor, MI, 48109, USA

    Jacqueline S. Jeruss

  5. Northwestern Feinberg School of Medicine, Northwestern Memorial Hospital, 676 N. St Clair Ave, Suite 2310, Chicago, IL, 60611, USA

    Mary Ellen Pavone

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  1. Molly B. Moravek
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  2. Rafael Confino
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  3. Angela K. Lawson
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  6. Susan C. Klock
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  8. Jacqueline S. Jeruss
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Correspondence to Mary Ellen Pavone.

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Conflict of interest

Authors Molly B. Moravek, Rafael Confino, Angela K. Lawson, Kristin N. Smith, Ralph R. Kazer, Susan C. Klock, Jacqueline S. Jeruss and Mary Ellen Pavone declares that they have no conflict of interest. William J. Gradishar is the Editor-in-Chief of Breast Cancer Research and Treatment.

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Moravek, M.B., Confino, R., Lawson, A.K. et al. Predictors and outcomes in breast cancer patients who did or did not pursue fertility preservation. Breast Cancer Res Treat 186, 429–437 (2021). https://doi.org/10.1007/s10549-020-06031-4

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  • DOI: https://doi.org/10.1007/s10549-020-06031-4

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