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Session Fertility and Pregnancy 13-10-2006. FL-BBM 20062 Specific questions Risk of premature ovarian failure Ability to become pregnant Safety of pregnancy.

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Presentation on theme: "Session Fertility and Pregnancy 13-10-2006. FL-BBM 20062 Specific questions Risk of premature ovarian failure Ability to become pregnant Safety of pregnancy."— Presentation transcript:

1 Session Fertility and Pregnancy 13-10-2006

2 FL-BBM 20062 Specific questions Risk of premature ovarian failure Ability to become pregnant Safety of pregnancy Influence of BC treatment on offspring Contraception options Thewes, B. et al. J Clin Oncol; 23:5155-5165 2005

3 Fertility concerns among young women with breast cancer Fabienne Liebens MD Breast Unit- CHU Saint Pierre Brussels

4 FL-BBM 20064 Why do we need to address this issue? To what extent are women with BC concerned by their fertility? How do health professionals communicate about this matter? Guidelines? Fertility concerns among women with breast cancer

5 FL-BBM 20065 Why do we need to address this issue? Why do we need to address this issue? Fertility concerns among women with breast cancer The incidence of breast cancer has increased by 0.5% per year over the past decade, whereas the death rate decreased by 1.4% per year during the same period. (Ghafoor A, CA Cancer J Clin 2003). 25% of breast cancer cases occur before the age of menopause, –15% occur under the age of 45.

6 FL-BBM 20066 Why do we need to address this issue? Why do we need to address this issue? Fertility concerns among women with breast cancer In Belgium per year 30-34 yrs: 125 cases 35-39 yrs: 250 cases 40-44 yrs: 500 cases

7 FL-BBM 20067 Why do we need to address this issue? Why do we need to address this issue? Fertility concerns among women with breast cancer Polyagent chemotherapy 13% to 98% –Risk of menopause range from 13% to 98% Variability related to –Definitions of menopause –Patient (age) and treatment characteristics –Follow up duration Sonmezer, M. et al. Oncologist 2006;11:422-434

8 FL-BBM 20068 Why do we need to address this issue? Why do we need to address this issue? Fertility concerns among women with breast cancer There have been recent advances in the field of fertility preservation. Donnez J et al, 2004

9 FL-BBM 20069 Why do we need to address this issue? To what extent are women with BC concerned by their fertility?To what extent are women with BC concerned by their fertility? How do health professionals communicate about this matter? Guidelines? Fertility concerns among women with breast cancer

10 FL-BBM 200610 Partridge, A. H. et al. J Clin Oncol; 22:4174-4183 2004 Web-Based Survey of Fertility Issues in Young Women With Breast Cancer Premenopausal Age < = 40 years at the time of breast cancer diagnosis.

11 FL-BBM 200611 Partridge, A. H. et al. J Clin Oncol; 22:4174-4183 2004 Web-Based Survey of Fertility Issues in Young Women With Breast Cancer 57%Concerned about becoming infertile: 57% –most common among women who had a desire for future children regardless of their age or stage of disease, 29%Infertility influenced their decisions about treatment: 29%

12 FL-BBM 200612 Partridge, A. H. et al. J Clin Oncol; 22:4174-4183 2004 Web-Based Survey of Fertility Issues in Young Women With Breast Cancer Discussion fertility issues: 72% –17% discussed these issues with fertility specialists. Satisfaction after discussing the issue: 51% Fertility concerns had not been adequately addressed: 26%

13 FL-BBM 200613 Partridge, A. H. et al. J Clin Oncol; 22:4174-4183 2004 Perceived percentage likelihood of menopause with therapy among young women with breast cancer Web-Based Survey of Fertility Issues in Young Women With Breast Cancer

14 FL-BBM 200614 Fertility- Related Information Needs of Younger Women With Early BC. Thewes, B. et al. J Clin Oncol; 23:5155-5165 2005 p <.001 May change over time

15 FL-BBM 200615 Top 10 questions about fertility Fertility- and Menopause-Related Information Needs of Younger Women With Early BC. Thewes, B. et al. J Clin Oncol; 23:5155-5165 2005 What should I be doing about contraception? 106 (47.1%) Am I currently fertile? 94(41.8%) Am I going to be able to become pregnant after treatment? 94(41.8%) If I become infertile, does it happen immediately? 52(23.3%) What are the statistics about my chances of becoming pregnant? 63(28.4%) Would a future pregnancy influence my prognosis (my chances of a recurrence)? 58(26%)

16 FL-BBM 200616 Fertility- Related Information Needs of Younger Women With Early BC. Thewes, B. et al. J Clin Oncol; 23:5155-5165 2005 –Younger women, –Women with plans for childbearing at diagnosis, –Women with no children at diagnosis, –Women who were single. Which women were significantly more likely to rate fertility-related information as extremely important?

17 FL-BBM 200617

18 FL-BBM 200618 Why do we need to address this issue? To what extent are women with BC concerned by their fertility? How do health professionals communicate about this matter?How do health professionals communicate about this matter? Guidelines? Fertility concerns among women with breast cancer

19 FL-BBM 200619 Discussions Regarding Reproductive Health for Young Women With Breast Cancer Undergoing Chemotherapy Duffy CM, Journal of Clinical Oncology, Vol 23, No 4, 2005: pp. 766-773 Communication between health professionals and patients Questionnaire interview N: 166 Age < = 45 Stage I-III Before chemotherapy

20 FL-BBM 200620 Discussions Regarding Reproductive Health for Young Women With Breast Cancer Undergoing Chemotherapy Duffy CM, Journal of Clinical Oncology, Vol 23, No 4, 2005: pp. 766-773 The median number of physicians: 4 All women: oncologist and surgeon More than half: radiation oncologist, obstetrician/gynecologist, or primary care physician.

21 FL-BBM 200621 Issue discussed Discussions Regarding Reproductive Health for Young Women With Breast Cancer Undergoing Chemotherapy Duffy CM, Journal of Clinical Oncology, Vol 23, No 4, 2005: pp. 766-773 The possibility of early menopause: 68%. Fertility: 34%. Side effects of treatment: 98%.

22 FL-BBM 200622 Physician discussing side effects by specialty Discussions Regarding Reproductive Health for Young Women With Breast Cancer Undergoing Chemotherapy Duffy CM, Journal of Clinical Oncology, Vol 23, No 4, 2005: pp. 766-773 Medical Impact Discussed Type of Medical Provider (%) All Physicians (n = 144) Medical Oncologist (n = 144) Surgeon (n = 144) Radiation Oncologist (n = 83) Family Practice (n = 80) OB/GYN (n = 84) Menopause 68.261.124.37.26.313.1 Fertility 34.128.59.06.02.54.8 Side effects 98.596.537.544.615.07.1 Impact on normal activities 90.084.041.728.96.32.3 Percent of All Physicians Discussing Side Effects, by Specialty n = number of women reporting seeing that physician regarding breast cancer.

23 FL-BBM 200623 Are guidelines available?

24 FL-BBM 200624 Lee, S. J. et al. J Clin Oncol; 24:2917-2931 2006 ASCO GUIDELINES 2006

25 FL-BBM 200625 EUROPA DONNA Working Group for Young Women with Breast Cancer Concerns and Priorities Raising awareness of breast cancer in young women amongst gynaecologists and other doctors, through training Being informed about side effects of treatment, such as hormonal therapy and symptoms of early menopause Having access to information about clinical trials, their results and how to participate in them Understanding the fertility issues, the possibilities of becoming a mother in the futureUnderstanding the fertility issues, the possibilities of becoming a mother in the future Knowing the prospects for adoption and being eligible as a breast cancer survivorKnowing the prospects for adoption and being eligible as a breast cancer survivor

26 FL-BBM 200626 Conclusion Conclusion Fertility concerns among women with breast cancer The available evidence suggests that fertility preservation is of great importance to many young women diagnosed with breast cancer Infertility resulting from cancer treatment may be associated with psychosocial distress Clinicians should not assume that women who are younger or have better prognoses are more interested in exploring fertility issues.

27 FL-BBM 200627 Conclusion Conclusion Fertility concerns among women with breast cancer It may be impossible for physicians to know how important fertility preservation is to their patients unless they ask –about plans for childbearing –about preferred amount of information when discussing fertility Clinicians should provide information about the impact of adjuvant treatment on fertility status in a timely fashion before treatment begins, so that women can explore fertility-preserving options. Participation in clinical trials in centers with the necessary expertise should be encouraged.

28 FL-BBM 200628 Fighting Breast Cancer is giving Hope. … Fighting Breast Cancer is giving Hope. Europa Donna Belgium

29 FL-BBM 200629 Top 10 questions about fertility Fertility- and Menopause-Related Information Needs of Younger Women With Early BC. Thewes, B. et al. J Clin Oncol; 23:5155-5165 2005 What should I be doing about contraception?106 (47.1%) Am I currently fertile?94 (41.8%) Am I going to be able to become pregnant after treatment?94 (41.8%) What are the risks or benefits of having a child after breast cancer?41 (18.3%) How long after treatment can I check whether I'm still fertile?38 (17%) What has happened to other breast cancer survivors who have decided to have children? 42 (18.7%) Are there any health concerns for children I might have in the future as a result of my treatment? 30 (13.3%) If I become infertile, does it happen immediately?52 (23.3%) What are the statistics about my chances of becoming pregnant? 63 (28.4%) Would a future pregnancy influence my prognosis (my chances of a recurrence)? 58 (26%)

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