Fertility Concerns Prevent Patients with Breast Cancer from Seeking Treatment

Desire for future fertility has a negative impact on adherence to tamoxifen regimen.

Desire for future fertility has a negative impact on adherence to tamoxifen regimen.

Young women with breast cancer have rising concerns about the possibility of infertility caused by treatment with tamoxifen. The concerns caused a third of women affected with breast cancer to deny treatment or cease treatment despite the fact that tamoxifen has a known benefit in reducing the risk of breast cancer recurrence, according to a recent study.

“Our study points toward the importance of fertility to young breast cancer patients. We need to find a way to bridge the gap between this patient survivorship goal and our concerns as physicians to facilitate the best treatment possible for our patients,” said study senior author Jacqueline Jeruss, MD, PhD, associate professor of surgery and biomedical engineering at the University of Michigan and a breast cancer surgeon at the University of Michigan Comprehensive Cancer Center.

The study evaluated the electronic medical records of 515 premenopausal women treated for breast cancer at Northwestern Memorial Hospital’s Lynn Sage Comprehensive Breast Center. The patients included in the study were those that had estrogen receptor- or progesterone receptor-positive breast cancer and were recommended to take tamoxifen.

Studies on the drug showed a 47% reduction in recurrence risk, as well as a 26% reduction in mortality. In addition, more recent data suggests that continuing the regimen for 10 years may be even more beneficial in preventing recurrence or death.

The researchers found in the current study that 13% of patients declined to take tamoxifen despite its known benefits, while 16% stopped taking the medication before its recommended timeframe.

The most common factors in those who denied treatment were a diagnosis of ductal carcinoma in situ, declining radiation therapy, not receiving chemotherapy, and expressing a desire for future fertility.

The expressed desire for future fertility was also common among those discontinuing their treatment.

To confirm the findings in patient records, researchers conducted phone interviews with 88 patients in the study. Concerns about fertility and side effects were the primary factors patients mentioned as influencing their decisions about taking or staying on tamoxifen.

“This study shines a bright light on the fertility concerns of young cancer patients. Through the Oncofertility National Physicians Cooperative program, fertility concerns for young cancer patients can now be addressed,” said Teresa K. Woodruff, PhD, director of the Oncofertility Consortium based at Northwestern University Feinberg School of Medicine. “If provided at the time of diagnosis, this may ensure more young women with a cancer diagnosis adhere to their life-preserving tamoxifen treatments.”

Those taking tamoxifen are advised against pregnancy due to the risk factors the drug poses to the fetus. The authors emphasize a need for further counseling and education to those who may be at higher risk for declining treatment with tamoxifen.

An additional study is underway to evaluate if patients who express a desire to get pregnant and cease tamoxifen temporarily will receive the same benefits from the drug as will those who take it continuously. Additionally, options do exist prior to treatment for patients expressing concerns about preserving fertility, however, these options may not be covered by insurance.