Fertility Issues in Young Patients with Breast Cancer

Objective: To review the need for fertility preservation in young patients with breast cancer. Materials and Methods: This retrospective study includes patients ≤ 40 years with breast carcinoma treated at Action Cancer Hospital, New Delhi, from June 2010 to 31 July 2014. Patient age, marital status, parity, contraception use, and the need for fertility preservation were evaluated. Result: Fifty-three patients were included in study with mean age 35.4 (SD: 4.1) years. Fifty (94.3%) patients were married, and four (7.5%) were nulliparous. All had regular menstrual cycles before treatment except one who had premature menopause. Thirty (56.6%) patients had used some form of contraception. Forty-eight patients underwent modified radical mastectomy, and five patients had breast conservative surgery. Most common histopathology was infiltrating duct carcinoma in fifty (94.3%) patients. Tumor was hormone responsive in twenty-four (45.3%) cases and triple negative in twenty one (39.6%) cases. Neo-adjuvant chemotherapy was given in four (7.5%) patients, adjuvant chemotherapy was given in fifty-one (96.2%) patients, thirty-three (62.3%) patients received adjuvant radiotherapy, and adjuvant hormone therapy was received by thirty-one (58.5%) patients. None of these patients were counseled regarding their fertility concerns, none was referred to oncofertility specialist before starting the treatment, and none was investigated for their future fertility prospects. No one was aware of fertility preservation methods. Fertility was desired by only nine (17%) patient at the time of diagnosis out of which four were nulliparous and five patients had single live issue. Conclusion: In India, most women get married at early age and complete their family early. However, few patients are unable to complete their family at the time of diagnosis of breast cancer and need fertility preservation. Oncofertility counseling is of great importance to many young women diagnosed with cancer and should be managed in a multi-disciplinary background. All options of fertility preservation should be discussed with them before starting treatment.