Abstract P2-12-12: Breast cancer in young women: Fertility preservation as a component of treatment planning and discussion
Authors: Nunes Hugo , Vaz Fátima , Brito Margarida , Melo Cláudia , Almeida Santos Ana Teresa , Moreira António 
Published: May 2015

Background: as part of education and informed consent before cancer therapy, health care providers should address the possibility of infertility with patients (pts) treated during their reproductive years, and be prepared to discuss fertility preservation options and/or to refer all potential patients to Reproductive Specialists. I here we describe the recently established referral protocol of our institution with a fertility preservation centre. Both institutions belong to the Portuguese National Health System.

Methods: the referral protocol includes female pts, ≤ 39 years old, with a diagnosis of breast or gynecological cancer or sarcoma with indication to curative intention chemotherapy. The possibility of fertility preservation is primarily discussed at the cancer centre and only interested pts are referred to the reproductive clinic, where specialized counseling is provided. Fertility preservation procedures (FPPs) (oocyte, embryo and/or ovarian tissue cryopreservation) are conditional to a previous evaluation of the ovarian pool (OP). OP markers are: antral follicle count, follicle stimulating hormone (FSH) and anti-mullerian hormone (AMH). Only good prognosis cases are eligible for FPPs.

Results: After primary discussion with eligible breast cancer (BC) pts, 17 were referred to the reproductive clinic: median age at BC diagnosis was 34 yrs (29-38), median previous pregnancies number of 0 (0-2) and median number of children of 0 (0-2). Marital status: most (64%) pts had a companion but 36% did not. All pts except 1 were candidates for immediate chemotherapy, either in the adjuvant or neoadjuvant setting. In the adjuvant setting (9 pts), median time from surgery until starting systemic treatment was 61.5 (43-146) days (aprox. 8,8 weeks); the case with a 146 day interval before chemotherapy was due to surgical complications and not to FPP. In the neoadjuvant setting (5 pts), median time between multidisciplinary decision and systemic treatment beginning was 17 (11-24) days (2,4 weeks). One patient was proposed to hormone therapy only after BC surgery and underwent FPP before systemic treatment. The timing for primary discussion of FPP was in multidisciplinary decision consultation. After counselling at the reproductive clinic, 2 pts declined FPP (%). For the other 13 pts oocyte cryopreservation was the FPP mostly used, although in one case embryo cryopreservation was performed. One case of ovarian hyperstimulation syndrome was observed but this FPP complication resolved without sequela and this event did not cause delay in chemotherapy treatment.

Conclusions: our collaboration protocol allows for an efficacious referral of BC pts seeking fertility preservation counselling. Although BC patients may be focused initially on their cancer diagnosis, health care providers are encouraged to advise them regarding potential threats to fertility. Formal collaboration between cancer and reproductive centres, like the one described here, are crucial so as to allow for the widest array of options for fertility preservation and to prevent delay in cancer treatment. We intend to follow up these patients in order to realistically understand the impact of this practice in fertility and quality of life of cancer patients.

Citation Format: Hugo Nunes, Fátima Vaz, Margarida Brito, Cláudia Melo, Ana Teresa Almeida Santos, António Moreira. Breast cancer in young women: Fertility preservation as a component of treatment planning and discussion [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-12-12.