Abstract PD12-05: Fertility preservation in young women with breast cancer: Impact on treatment and outcomes
Authors: Crown Angelena , Muhsen Shirin , Sevilimedu Varadan , Kelvin Joanne , Goldfarb Shari B , Gemignani Mary L 
Published: February 2021

Abstract
Background. The American Society of Clinical Oncology guidelines recommend timely referral to reproductive endocrinology and infertility (REI) specialists for young women diagnosed with breast cancer. There is a paucity of data evaluating the impact of FP on oncologic outcomes and timely initiation of chemotherapy.
Methods. This retrospective review included all women age ≤ 45y diagnosed with stage I-III unilateral breast cancers at Memorial Sloan Kettering Cancer Center between 2009-2015 who received chemotherapy and consulted with an REI specialist. Factors associated with the decision to undergo FP were analyzed. Survival curves were constructed using the Kaplan-Meier method.
Results. A total of 172 women were identified. Median age was 34y (interquartile range 31-37). The majority of women were single (n = 99, 58.1%) and nulliparous (n = 134, 77.9%). Most women underwent FP (n = 121, 70.3%). Tumor characteristics and treatments were similar between women who underwent FP and those who declined (Table 1). While white race was associated with decision to pursue FP, this association did not persist on multivariable analysis (MVA). Young age (p = 0.003), nulliparity (p = 0.001), referral from Breast Surgery (p = 0.009), and private insurance (p &lt; 0.001) were independent predictors of FP on MVA. Timing of chemotherapy (adjuvant vs neoadjuvant) was not associated with decision to undergo FP. FP was not associated with breast cancer treatment delays.
A total of 25.5% (n = 44) of women had a biological child following breast cancer treatment (Table 2). Women who underwent FP were more likely to have a biological child after breast cancer treatment. Race and insurance type were also associated with having a biological child after treatment, with white women and women with private insurance being more likely to have a biological child. MVA revealed that undergoing FP, being married, and being white were independent predictors of having a biological child.
The 5-year overall survival (OS) was 97.5% (95% CI: 93.5-99.1%) and the 5-year recurrence-free survival (RFS) was 91.4% (95% CI: 85.9%-94.8%) with a median follow-up of 70 months (range 4-127). Five-year overall survival (OS) and recurrence-free survival (RFS) were similar between women who underwent FP and those who declined (OS: FP 98.2%, 95% CI 92.9%-99.5% vs 95.9%, 95% CI 84.6-98.9%, p = 0.20 and RFS: FP 92.1%, 95% CI: 85.4-95.8% vs declined 89.7%, 95% CI 76.9-95.6%, p = 0.42). Disease stage, race, and pregnancy were not associated with differences in OS or RFS. Private insurance was associated with improved OS but not with improved RFS.
Conclusions. Most women underwent FP. Women pursued FP at high rates independent of the timing of chemotherapy and oncologic factors. These findings indicate that timely consultation with REI specialists is the key factor in completing FP, and highlight opportunities for improved education and counseling regarding FP. They also identify FP as a possible area of racial disparities within breast cancer care, and serve as a reminder of the complex interplay between socioeconomic factors, reproductive choices, and pregnancy outcomes.
Table 1. Factors associated with decision to pursue cryopreservationFactorsDeclined Cryopreservation (n = 51)Cryopreservation (n = 121)p valueMedian Age, years (IQR)37 (32-40)33 (30-37)&lt; 0.001RaceWhite26 (56.5%)86 (78.2%)0.015Black10 (21.7%)7 (6.3%)Asian9 (19.6%)15 (13.6%)Other1 (2.2%)2 (1.8%)Unknown511Insurance TypePrivate39 (76.5%)114 (94.2%)&lt; 0.001Government11 (21.6%)4 (3.3%)Uninsured1 (2.0%)3 (2.5%)Single29 (56.9%)70 (57.9%)&gt; 0.99Nulligravid21 (41.2%)80 (66.1%)0.004Nulliparous31 (60.8%)103 (85.1%)&lt; 0.001Referring ServiceBreast Surgery24 (47.1%)87 (71.9%)0.004Breast Medicine26 (51.0%)33 (27.3%)Genetics/GYN1 (2.0%)1 (0.8%)Tumor GradeI2 (4.0%)2 (1.7%)0.52II7 (14.0%)14 (11.8%)III41 (82.0%)103 (86.6%)Unknown12Receptor ProfileER/PR+ HER2-31 (60.8%)64 (52.9%)0.74ER/PR+ HER2+8 (15.7%)27 (22.3%)ER/PR- HER2+2 (3.9%)4 (3.3%)Triple Negative10 (19.6%)26 (21.5%)StageI12 (23.5%)44 (36.4%)0.074II27 (52.9%)63 (52.1%)III12 (23.5%)14 (11.6%)Breast SurgeryLumpectomy19 (37%)38 (31.4%)0.57Mastectomy32 (63%)83 (68.6%)Systemic TherapyAdjuvant Chemotherapy43 (84.3%)104 (86.0%)0.97Median Time from Surgery to Chemotherapy, weeks (range)7 (4-19)7 (2-18)0.9Delay &gt; 12 Weeks to Chemotherapy2 (4.7%)3 (2.9%)0.63Neoadjuvant Chemotherapy8 (15.7%)17 (14.0%)0.97Median Time from Diagnosis to NAC, weeks (range)3 (1-8)3 (2-12)0.29Delay &gt; 6 weeks to chemotherapy start1 (12.5%)2 (11.8%)&gt; 0.99Endocrine Therapy41 (80.4%)92 (76.0%)0.67Radiation TherapyAdjuvant Whole Breast Radiation Therapy16 (31.4%)38 (31.4%)0.99PMRT16 (31.4%)43 (35.5%)0.73IQR interquartile range, IDC invasive ductal carcinoma, ILC invasive lobular carcinoma, DCIS ductal carcinoma in situ, ER estrogen receptor. “Unknowns” were not included in percentage calculations or in univariate analysis.
Table 2. Factors associated with having a biological child after breast cancer treatmentFactorsHad a biological child (n = 44)Did not have a biological child (n = 128)p valueCompleted fertility preservation40 (90.9%)81 (63.3%)0.001RaceWhite36 (90.0%)76 (65.5%)0.029Black1 (2.5%)16 (13.8%)Asian3 (7.5%)21 (18.1%)Other03 (2.6%)Unknown412Insurance TypePrivate40 (90.9%)113 (88.3%)0.020Government1 (2.3%)14 (10.9%)Uninsured3 (6.8%)1 (0.8%)Married30 (68.2%)43 (33.6%)&lt;0.001Nulligravid24 (54.5%)77 (60.2%)0.64Nulliparous32 (72.7%)102 (79.7%)0.45Referring ServiceBreast Surgery33 (75.0%)48 (37.5%)0.22Breast Medicine11 (25.0%)78 (60.9%)Genetics/GYN02 (1.6%)Tumor FactorsTumor GradeI1 (2.4%)3 (2.3%)&gt; 0.99II5 (11.9%)16 (12.6%)III36 (85.7%)108 (85.0%)Unknown21StageI19 (43.2%)37 (28.9%)0.21II19 (43.2%)71 (55.5%)III6 (13.6%)20 (15.6%)Breast Cancer TreatmentMastectomy32 (72.7%)83 (64.8%)0.44ALND15 (34.1%)51 (39.8%)0.62Systemic TherapyAdjuvant Chemotherapy39 (88.6%)108 (84.4%)0.66Neoadjuvant Chemotherapy5 (11.4%)20 (15.6%)Radiation Therapy26 (59.1%)87 (68.0%)0.38IDC invasive ductal carcinoma, ILC invasive lobular carcinoma, DCIS ductal carcinoma in situ, ER estrogen receptor. “Unknowns” were not included in percentage calculations or in univariate analysis.
Citation Format: Angelena Crown, Shirin Muhsen, Varadan Sevilimedu, Joanne Kelvin, Shari B Goldfarb, Mary L Gemignani. Fertility preservation in young women with breast cancer: Impact on treatment and outcomes [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD12-05.