Young Women with Breast Cancer Often Forgo Hormone Therapy Due to Fertility Concerns

Receiving a breast cancer diagnosis at a young age can be very unexpected and carry with it unique concerns. Among those concerns is a possible loss of fertility. A new study says this worry can often impact which treatments women will undergo.

Researchers from Dana-Farber Cancer Institute spoke with young women navigating a breast cancer diagnosis about their health history, fertility concerns, and treatment decisions. They found that these women often forgo or put off hormone-blocking therapy due to concerns about fertility. Their findings were published in the journal Cancer.

The study’s lead author, Dr. Tal Sella from Dana-Farber, says, “For many premenopausal women with hormone receptor-positive breast cancer, long-term endocrine therapy [which blocks hormones that feed the cancer’s growth] may prevent patients from having children while treatment is under way. In this study, we explored the degree to which fertility concerns affect patients’ decisions about receiving such therapy.”

To conduct the study, researchers surveyed participants from the Young Women’s Breast Cancer Study, which follows more than 1,300 women diagnosed with breast cancer before the age of 40 between 2006 and 2016. The Dana-Farber team quizzed 643 of these women on topics like their medical history, current medications, fertility concerns, and hormone therapy decisions. This was followed up every six months for the next three years and on an annual basis following that. All of the women involved had been diagnosed with hormone receptor-positive, stage I-III breast cancer.

Women with this type of cancer are usually on hormone therapy for at least five years after surgery and chemotherapy. This is to lower the chance of a recurrence because tumors involved in this form of the disease often grow due to estrogen and progesterone. Study authors say research shows the therapy may lower the risk of the cancer returning by about 50%.

In the first two years following diagnosis, one-third of participants said fertility concerns played a role in their decisions regarding hormone therapy. Of this group, 40% said they either chose to forgo or discontinue this treatment, while only 20% of those who weren’t concerned about fertility made similar decisions.

Two-thirds of women who didn’t get the therapy at all or who stopped getting it reported a pregnancy or an attempt to become pregnant during those two years. Meanwhile, researchers found that women who already had children were less apt to let their treatment decisions be influenced by efforts to have more children.

Senior author, Shoshana Rosenberg, ScD, MPH, says, “Our findings shed new light on the dilemma facing many young women with hormone receptor-positive breast cancer: whether to optimize adjuvant treatment or fulfill their desire for children in the near term. Physicians can best help their patients by understanding their goals and developing treatment strategies that incorporate their needs.”

According to the National Cancer Institute, about half of young women diagnosed with breast cancer say they want to have a child after completing treatment. The agency referenced a Swedish study which found fertility preserving methods were safe for breast cancer patients to use before beginning treatment. The study, which followed nearly 1,300 women, also found that 171 later had successful pregnancies. That included both women who did and women who did not undergo fertility preserving efforts.

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