Viable Options for Fertility Preservation in Breast Cancer Patients: A Focus on Latin America

Abstract

Thanks to the improved survival outcomes observed in recent years, a growing attention has been given to the quality of life issues faced by young women with breast cancer such as fertility preservation and concerns related to future pregnancies.However, several challenges remain for young women with breast cancer considering undergoing fertility preservation strategies.Further specific issues on this regard should be taken into account in Latin America, where patients and physicians face particular barriers that hinder the routine adoption of this practice. Hence, further efforts are needed to overcome these deficiencies and improve the correct referral of breast cancer patients to fertility preservation strategies.The aim of the present review is to focus on the risk of anticancer treatment-related premature ovarian failure and infertility in young breast cancer patients, to summarize the current knowledge on the available options for fertility preservation, and to discuss the safety issues of pregnancy in breast cancer survivors. Furthermore, this review aims to highlight the specific clinical challenges in this field encountered by healthcare providers and young breast cancer patients from Latin American countries. (REV INVES CLIN. 2017;69:103-13)

The PREgnancy and FERtility (PREFER) study: an Italian multicenter prospective cohort study on fertility preservation and pregnancy issues in young breast cancer patients

“…International guidelines recommend an early and prompt discussion about the possible risk of developing these side effects with all young patients who are candidates to receive anticancer therapies to help them with informed decisions on the available strategies for fertility preservation [8–10]. Embryo/oocyte cryopreservation, cryopreservation of ovarian tissue and the use of temporary ovarian suppression with luteinizing hormone-releasing hormone analogs (LHRHa) during chemotherapy are the available options to preserve fertility in breast cancer patients [11]. Despite a growing literature on this topic over the past years, there are still several obstacles limiting the access to fertility preservation procedures [11, 12].…”

“…Embryo/oocyte cryopreservation, cryopreservation of ovarian tissue and the use of temporary ovarian suppression with luteinizing hormone-releasing hormone analogs (LHRHa) during chemotherapy are the available options to preserve fertility in breast cancer patients [11]. Despite a growing literature on this topic over the past years, there are still several obstacles limiting the access to fertility preservation procedures [11, 12]. Moreover, very limited data are available on the number of patients that take active steps towards the available strategies for fertility preservation and on the reasons for refusal of these procedures after oncofertility counseling.…”

Physicians' Attitudes, Knowledge, and Perceived Barriers toward Fertility Preservation in Young Breast Cancer Patients in a Developing Country

“…In particular, limited knowledge may be a determining barrier among Mexican physicians. Despite current data supporting the long-term safety of pregnancy after BC [24][25][26] , 24% of participants considered that pregnancy after BC negatively affects prognosis, as compared to 12.5% of physicians in the study by Lambertini et al 21 . Deficient knowledge was also evident in the use of GnRHa, regardless of current recommendations on temporary ovarian suppression during chemotherapy with GnRHa for ovarian protection and fertility preservation 27,28 , as 20% considered their use negatively affects prognosis in all BC patients, and another 20% believed that prognosis is negatively affected only in HR+ disease.…”

“…This rate is higher than that reported by Lambertini et al, where 14.3% of participants agreed that ovarian suppression with GnRHa during chemotherapy should be proposed only to women with hormone-receptor negative BC 21 . As for physicians' knowledge on the safety of concomitant administration of letrozole or tamoxifen during controlled ovarian hyperstimulation to avoid the possible detrimental impact of high estradiol levels on cancer cells 25 , 17% of our participants considered that ovulation inducers negatively affect prognosis in all BC patients, and 23% believed prognosis is negatively affected only in HR+ disease, which highly resembles the numbers found by Lambertini et al 21 Even though referrals to oncofertility specialists in Mexico are higher than those reported in other countries 14,[18][19][20]22 , it is presumed that a very low proportion of patients actually undergoes preservation procedures, as shown in our previous study 12 . Limited access to fertility preservation could be tackled through public health policies granting universal access to preservation strategies to all Mexican YWBC.…”

Burning Questions in the Oncofertility Counseling of Young Breast Cancer Patients

“…Managing these issues remains not always optimal due to both inadequate expertise of treating physicians and disparities in access to fertility care services making the availability of services related to oncofertility counseling extremely heterogeneous worldwide. 108 Providing financial coverage for fertility preservation represents an important commitment to reduce health disparities by providing broaden access to all patients. 109 It is now clear that more than 50% of patients who will undergo cytotoxic treatments are concerned about the possible future effects of cytotoxic treatments and it is the role of healthcare providers to give the right answers to these needs.…”