In the US, breast cancer is the most common invasive cancer in women, with more than 200,000 diagnosed with the disease each year. Approximately 25% of these women will be diagnosed before they experience menopause. Because childbearing often is delayed until later in life, many premenopausal young women with breast cancer may not have started to have children or completed their families.
Improved public awareness, routine diagnostic testing with mammography, and medical advances in treatment have greatly increased the chances of long-term survival following a diagnosis of breast cancer. The life-saving treatment of breast cancer often profoundly affects fertility, leaving many women unable to fulfill childbearing goals.[3,4] For all women, breast cancer is a crisis; for young women desiring children, the combined threat to life and fertility is likely catastrophic.
Infertility following treatment is related to gonadotoxic chemotherapeutic agents and/or the length of time required to complete treatment. Age at diagnosis is a major factor, as fertility naturally declines with age; women in their later childbearing years are at an increased risk for ovarian failure and permanent infertility. Ovarian function following treatment is also related to ovarian function at the time treatment began and the specific chemotherapeutic agents prescribed (eg, see Table 1).[6,7]
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3. Maltaris T, Weigel M, Mueller A, et al: Cancer and fertility preservation: Fertility preservation in breast cancer patients. Breast Cancer Res 10(2):206, 2008.
4. Hickey M, Peate M, Saunders CM, et al: Breast cancer in young women and its impact on reproductive function. Hum Reprod Update 15(3):323–339, 2009.
5. Gadducci A, Cosio S, Genazzani AR: Ovarian function and childbearing issues in breast cancer survivors. Gynecol Endocrinol 23(11):625–631, 2007.
6. Lee SJ, Schover LR, Partridge AH, et al: American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol 24(18): 2917–2931, 2006.
7. Sonmezer M, Oktay M: Fertility preservation in young women undergoing breast cancer therapy. Oncologist 11(5):422–434, 2006.
8. Partridge AH, Gelber S, Peppercorn J, et al: Web-based survey of fertility issues in young women with breast cancer. J Clin Oncol 22(20):4174–4183, 2004.
9. Thewes B, Meiser B, Taylor A, et al: Fertility- and menopause-related
information needs of younger women with a diagnosis of early breast cancer. J Clin Oncol 23(22):5155–5165, 2005.
10. Canada AL, Schover LR: Research promoting better patient education on reproductive health after cancer. J Natl Cancer Inst Monogr 34:98–100, 2005.
11. Avis NE, Crawford S, Manuel J: Psychosocial problems among younger women with breast cancer. Psychooncology 13(5):295–308, 2004.
12. Duffy CM, Allen SM, Clark MA: Discussions regarding reproductive health for young women with breast cancer undergoing chemotherapy. J Clin Oncol 23(4):766–773, 2005.
13. Dunn L, Fox KR: Techniques for fertility preservation in patients with breast cancer. Curr Opin Obstet Gynecol 21(1):68–73, 2009.
14. Oktay K, Karlikaya G: Ovarian function after transplantation of frozen, banked autologous ovarian tissue. N Engl J Med 342(25):1919, 2000.
15. Oktay K, Buyuk E, Rosenwaks Z, et al: A technique for transplantation of ovarian cortical strips to the forearm. Fertil Steril 80(1):193–198, 2003.
16. Oktay K, Economos K, Kan M, et al: Endocrine function and oocyte retrieval after autologous transplantation of ovarian cortical strips to the forearm. JAMA 286(12):1490–1493, 2001.
17. Cruz MR, Prestes JC, Gimenes DL, et al: Fertility preservation in women with breast cancer undergoing adjuvant chemotherapy: A systematic review. Fertil Steril March 30 2009; Epub ahead of print.
18. Gerber D, Dieterich M, Muller H, et al: Controversies in preservation of ovary function and fertility in patients with breast cancer. Breast Cancer Res Treat 108(1):1–7, 2008.
19. Schover LR: Psychosocial aspects of infertility and decisions about reproduction in young cancer survivors: A review. Med Pediatr Oncol 33(1):53–59, 1999.