Studies to Encourage Early Fertility Preservation Referral and to Predict Effects of Treatment on Fertility of Young women with Breast Cancer
Given that the average age at first pregnancy is 29 years these days, a high percentage of young women diagnosed with breast cancer have not yet completed their families. Although childbearing after breast cancer does not increase the risk of recurrence, many young women are no longer fertile after treatment. Adjuvant chemotherapy has deleterious effects on the ovaries, and hormonal therapy (now given for up to 10 years) will further delay pregnancy. Studies of young breast cancer patients have found that concerns about future child-bearing rank second only to fears of recurrence. The American Society of Clinical Oncology guidelines recommend the referral of women who wish to preserve their fertility to specialized clinics as soon as possible after their cancer diagnosis, ideally by their surgical team, in order to allow ample time for decision-making about stressful and expensive procedures such as oocyte or embryo cryopreservation. Yet in a recent survey of 188 Canadian breast cancer patients diagnosed before age 40, only 11% had completed their family prior to diagnosis, 25% had not had a fertility discussion and 50% of fertility discussions were patient-initiated.
Tools that summarize pros and cons of various fertility preservation options:
- Fertility Preservation Option Grid for Breast Cancer for Patients
- Fertility Preservation Option Grid for Breast Cancer for Physicians
What is the goal of this sub-project?
This sub-project has two goals:
- To increase fertility preservation knowledge and referrals among Canadian surgical oncologists.
- To determine pre- and post-treatment predictors of retained fertility or premature ovarian failure for young women with breast cancer.
What is the design of this sub-project?
The investigators will be conducting two simultaneous fertility studies to address these goals.
- SPOKE (Surgeon and Patient Oncofertility Knowledge Enhancement) is a fertility knowledge translation intervention for surgical oncologists to increase their fertility preservation knowledge and early referral of patients for fertility preservation. Baseline surgeon interviews and questionnaires will serve as a needs assessment for the creation of an oncofertility information resource toolbox, including a webinar. Physician and surgeon follow-up surveys will determine the success of the intervention.
- GYPSY (Giving Young women with breast cancer Predictors of Sterility post-chemotherapY) will monitor the effect over time of adjuvant treatment on the ovarian reserve of patients in the RUBY prospective cohort. The investigators wish to determine which women are likely to remain fertile for five or more years after chemotherapy based on age, genetic factors, baseline antimullerian hormone (AMH) levels and antral follicle count (AFC), and treatment. Annual AMH and AFC measures and patient reported menstrual status, pregnancy attempts and outcomes will be recorded. An additional goal is to be able to predict, based on the same parameters, which women are very unlikely to have a recovery of ovarian function after chemotherapy. All pre-menopausal, non-metastatic RUBY study participants will automatically be a part of the GYPSY study.
Why is this important?
SPOKE should lead to improved numbers and timeliness of fertility preservation referrals of young women with breast cancer. The results of GYPSY will lead to the creation of a model that will predict the probability that a young woman newly diagnosed with breast cancer will retain her fertility after treatment. This model would allow a woman to make an informed decision about whether to undergo fertility preservation, which is a stressful decision and is associated with high costs. Knowing which women will become amenorrheic after chemotherapy and unlikely regain ovarian function will also help clinicians identify women who will not require ovarian suppression or oophorectomy. These procedures are currently recommended as part of adjuvant hormonal therapy for young women with estrogen receptor–positive breast cancer, based on the recent results of the international Suppression of Ovarian Function (SOFT) study.
Who are the other investigators on this project?
- Dr. Karen Glass (Co-Investigator), CreATe Fertility Clinic
- Dr. Shu Fong (Co- Investigator), Calgary Regional Fertility Clinic
- Dr. Erin Kennedy (Co- Investigator), Mount Sinai Hospital
- Samantha Yee (Co- Investigator), University of Toronto
- Maureen Seminsky (Project co-ordinator, SPOKE)
We recently held a conference for RUBY investigators, during which Dr. Kutluk Oktay presented "The Ins & Outs of Fertility Preservation in Young Women with Breast Cancer." To view this presentation, click here.