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Surgeon and Patient Reports of Fertility Preservation Referral and Uptake in a Prospective, Pan-Canadian Study of Young Women with Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Prompt referral by their surgeon enables fertility preservation (FP) by young women with breast cancer (YWBC) without treatment delay. Following a FP knowledge intervention, we evaluated surgeon and patient reports of fertility discussion, FP referral offer and uptake, and FP choices and reasons for declining FP among patients enrolled in the Reducing Breast Cancer in Young Women, prospective pan-Canadian study.

Methods

Between September 2015 and December 2020, 1271 patients were enrolled at 31 sites. For each patient, surgeons were sent a questionnaire inquiring whether: (1) fertility discussion was initiated by the surgical team; (2) FP referral was offered; (3) referral was accepted; a reason was requested for any “no” response. Patients were surveyed about prediagnosis fertility plans and postdiagnosis oncofertility management.

Results

Surgeon questionnaires were completed for 1068 (84%) cases. Fertility was discussed with 828 (84%) and FP consultation offered to 461 (47%) of the 990 YWBC with invasive disease. Among the 906 responding YWBC, referral was offered to 220 (82%) of the 283 (33%) with invasive disease who stated that they had definitely/probably not completed childbearing prediagnosis. Of these, 133 (47%) underwent FP. The two most common reasons for not choosing FP were cost and unwillingness to delay treatment.

Conclusions

Although the rates of surgeon fertility discussion and FP referral was higher than most reports, likely due to our previous intervention, further improvement is desirable. FP should be offered to all YWBC at diagnosis, regardless of perceived childbearing intent. Cost remains an important barrier to FP uptake.

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Acknowledgment

This study was funded by a grant from the Canadian Institutes of Health Research and the Canadian Breast Cancer Foundation (#OBW139590). The authors thank all participating surgeons and women for without their collaboration, this manuscript would not be possible.

Author information

Author notes

  1. Carlos A. Carmona and Samantha Yee are co-first authors.

Authors and Affiliations

  1. Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada

    Carlos A. Carmona MD, Maureen Seminsky RN & Ellen Warner MD

  2. Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Carlos A. Carmona MD, Karen Glass MD & Ellen Warner MD

  3. CreATe Fertility Centre, Toronto, ON, Canada

    Samantha Yee PhD & Karen Glass MD

  4. Regional Fertility Program, Calgary, AB, Canada

    Shu Foong MD

  5. University of Calgary, Calgary, AB, Canada

    Shu Foong MD, Christine M. Friedenreich PhD, Susan Isherwood PhD & May Lynn Quan MD

  6. University of Guelph, Guelph, ON, Canada

    Eli Lipson BSc

  7. Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada

    Nancy N. Baxter MD

  8. Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Nancy N. Baxter MD

  9. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia

    Nancy N. Baxter MD

  10. Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada

    Christine M. Friedenreich PhD

  11. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada

    Kelly Metcalfe RN

  12. Women’s College Research Institute, Toronto, ON, Canada

    Kelly Metcalfe RN, Mohammad R. Akbari MD & Steven Narod MD

  13. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Mohammad R. Akbari MD & Steven Narod MD

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  1. Carlos A. Carmona MD
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  2. Samantha Yee PhD
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  14. Ellen Warner MD
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Correspondence to Ellen Warner MD.

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Carmona, C.A., Yee, S., Seminsky, M. et al. Surgeon and Patient Reports of Fertility Preservation Referral and Uptake in a Prospective, Pan-Canadian Study of Young Women with Breast Cancer. Ann Surg Oncol 29, 3022–3033 (2022). https://doi.org/10.1245/s10434-021-11254-w

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  • DOI: https://doi.org/10.1245/s10434-021-11254-w

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