Routine counseling on fertility preservation needed for young women with cancer

A new study has found that very few young women with cancer take steps to preserve their fertility while undergoing cancer therapy. Also, certain groups of young women are more likely to do so than others. Published early online in Cancer, a peer-reviewed journal of the American Cancer Society, the study indicates that efforts are needed to provide counseling on fertility preservation in reproductive-aged women diagnosed with cancer.

More than 120,000 women under 50 years of age are diagnosed with cancer each year in the United States. As cancer survival rates are improving, quality of life issues are becoming increasingly more relevant. For example, chemotherapy and other cancer therapies often increase a woman's risk of becoming infertile and experiencing early menopause, and a woman may regret losing the ability to bear children because of her cancer treatment. With widely available assisted reproductive techniques such as egg or embryo freezing, women who have been diagnosed with cancer have options to improve their chances of conceiving.

To find out which women are taking advantage of these fertility-preserving techniques, Mitchell Rosen, MD, of the University of California, San Francisco (UCSF), led a team that surveyed 1,041 women diagnosed with cancer between the ages of 18 and 40 years. Five cancer types were included: leukemia, Hodgkin's disease, Non-Hodgkin Lymphoma, breast cancer, and gastrointestinal cancer. The women were randomly sampled from the California Cancer Registry from 1993 to 2007. A total of 918 women were treated with therapies that could negatively affect their fertility (chemotherapy, pelvic radiation, pelvic surgery, or bone marrow transplant).

The investigators found that 61 percent of women received counseling on the risks of cancer treatment to their fertility from their doctors or other clinicians. Overall, only four percent of women pursued fertility preservation, but rates increased over time. (Only one percent pursued fertility preservation in 1993, compared with between six percent and 10 percent in 2005 to 2007.) Also, certain groups of women were more likely to receive important information about their reproductive health at the time of their cancer diagnosis and were also more likely to preserve their fertility than others.

Women who are childless, younger, Caucasian, heterosexual, and who graduated from college are more likely than women of other backgrounds to be counseled about the risks of cancer treatment to fertility or to preserve fertility before cancer treatment.

"Although more women are getting counseled regarding reproductive health risks, many women are still not receiving adequate information about their options at the time of cancer diagnosis," said Dr. Rosen. "Routine counseling regarding reproductive health risk and options for preserving reproductive potential will improve the quality of life among survivors, and the overall quality of care."

The authors concluded that socio-demographic health disparities likely affect access to fertility preservation services. "An opportunity lies ahead to explore educational and policy interventions to ameliorate health disparities that may exist in the growing use of fertility preservation," said Dr. Rosen.