Breast Cancer

, Volume 20, Issue 3, pp 230–240 | Cite as

Physicians’ knowledge, attitude, and behavior regarding fertility issues for young breast cancer patients: a national survey for breast care specialists

  • Chikako Shimizu
  • Hiroko Bando
  • Tomoyasu Kato
  • Yuri Mizota
  • Seiichiro Yamamoto
  • Yasuhiro Fujiwara
Original Article



Fertility is one of the key aspects of quality of life for breast cancer patients of childbearing age. The objective of this study was to describe fertility-related practice for young breast cancer patients in Japan and to identify healthcare provider factors that contribute to physicians’ behavior towards fertility preservation.


A cross-sectional survey was developed in order for Japanese breast cancer specialists (n = 843) to self-evaluate their knowledge, attitude, and behavior regarding fertility preservation. Survey items included questions regarding knowledge of and attitude toward fertility issues in cancer patients, fertility-related practice, potential barriers for the discussion of fertility with patients, and responding physicians’ socio-demographic background.


Four hundred and thirty-four (52%) breast oncologists responded to the survey. Female and younger oncologists (age less than 50 years) had significantly higher probability of referring patients to reproductive specialists. Physicians who had better knowledge score and positive attitudes toward fertility preservation were more likely to discuss potential fertility issues with cancer patients. This was significantly associated with consultation and referral to reproduction specialists when encountering fertility issues with cancer patients. Risk of recurrence, lack of collaborating reproductive specialists, and time constraints in the clinic were identified as major barriers to discussion of fertility preservation with breast cancer patients.


Female and younger physicians as well as physicians working in a multidisciplinary environment had positive attitudes and behavior towards fertility preservation in breast cancer patients. The development of comprehensive and interdisciplinary programs for healthcare providers is necessary to meet the expectations and fertility needs of breast cancer patients.


Fertility preservation Breast cancer Survivorship 


  1. 1.
    Canada AL, Schover LR. The psychosocial impact of interrupted childbearing in long-term female cancer survivors. Psychooncology. 2010 (Epub ahead of print).Google Scholar
  2. 2.
    Lee SJ, Schover LR, Partridge AH, Patrizio P, Wallace WH, Hagerty K, et al. American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol. 2006;2429:17–2931.Google Scholar
  3. 3.
    Kubo A, Koido K, Sawada M, Ryushima Y, Shimizu C, Kato T, Ando M, et al. Survey on oncologists provided information on treatment-related infertility to breast cancer patients. Gan to Kagakuryoho (Cancer Chemother). 2011 (in press).Google Scholar
  4. 4.
    Quinn GP, Vadaparampil ST, Lee JH, Jacobsen PB, Belper G, Lancaster J, et al. Physician referral for fertility preservation in oncology patients: a national study of practice behaviors. J Clin Oncol. 2009;27:5952–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Arafa MA, Rabah DM. Attitudes and practices of oncologists toward fertility preservation. J Pediatr Hematol Oncol. 2011;33:203–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Collins IM, Fay L, Kennedy MJ. Strategies for fertility preservation after chemotherapy: awareness among Irish cancer specialists. Ir Med J. 2011;104:6–9.PubMedGoogle Scholar
  7. 7.
    Peate M, Meiser B, Friedlander M, Zorbas H, Rovelli S, Sansom-Daly U, et al. It’s now or never: fertility-related knowledge, decision-making preferences, and treatment intentions in young women with breast cancer—an Australian Fertility Decision Aide Collaborative Group Study. J Clin Oncol. 2011 (Epub ahead of print).Google Scholar
  8. 8.
    Quinn GP, Vadaparamil ST, King L, Miree CA, Wilson C, Raj O, et al. Impact of physicians’ personal discomfort and patient prognosis on discussion of fertility preservation with young cancer patients. Patient Educ Couns. 2009;77:338–43.CrossRefPubMedGoogle Scholar
  9. 9.
    Japanese Breast Cancer Society. Breast cancer treatment guideline for patients 2009. Tokyo: Kanehara Shoten; 2010 (Japanese).Google Scholar
  10. 10.
    Japanese Breast Cancer Society. Breast cancer treatment guideline 2010. Tokyo: Kanehara Shoten; 2010 (Japanese).Google Scholar
  11. 11.
    Lee S, Heytens E, Moy F, Ozkavukcu S, Otkay K. Determinants of access to fertility preservation in women with breast cancer. Fertil Steril. 2011;95:1932–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Lee S, Ozkavukcu S, Heytens E, Moy F, Otkay K. Value of early referral to fertility preservation in young women with breast cancer. J Clin Oncol. 2010;28:4683–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Gerber B, Dieterich M, Muller H, Remer T. Controversies in preservation of ovary function and fertility in patients with breast cancer. Breast Cancer Res Treat. 2008;108:1–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Goldfarb S, Dickler M, McCabe M, Thom B, Jia X, Hudis C, et al. Oncology clinicians knowledge, attitude and practices regarding fertility preservation. J Clin Oncol. 2010;28(15 Suppl):e19525.Google Scholar
  15. 15.
    Kranick MA, Schaefer C, Rowell S, Desai M, Petrek JA, Hiatt RA, Senie RT. Is pregnancy after breast cancer safe? Breast J. 2010;16:404–11.PubMedGoogle Scholar
  16. 16.
    Oakman C, Santarpia L, Di Leo A. Breast cancer assessment tools and optimizing adjuvant therapy. Nat Rev Clin Oncol. 2010;7:725–32.CrossRefPubMedGoogle Scholar
  17. 17.
    Goldhirsch A, Ingle JN, Gelber RD, Coates AS, Thurlimann B, Senn HJ, Panel Members. Thresholds for therapies: highlights of the St Galln International Expert Consensus on the primary therapy of early breast cancer 2009. Ann Oncol. 2009;20:1319–29.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Breast Cancer Society 2012

Authors and Affiliations

  • Chikako Shimizu
    • 1
  • Hiroko Bando
    • 2
  • Tomoyasu Kato
    • 3
  • Yuri Mizota
    • 4
  • Seiichiro Yamamoto
    • 4
  • Yasuhiro Fujiwara
    • 1
  1. 1.Breast and Medical Oncology DivisionNational Cancer Center HospitalTokyoJapan
  2. 2.Breast and Endocrine Surgery, Graduate School of Comprehensive Human SciencesUniversity of TsukubaTsukubaJapan
  3. 3.Division of GynecologyNational Cancer Center HospitalTokyoJapan
  4. 4.Center for Cancer Control and Information ServicesNational Cancer HospitalTokyoJapan

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