It’s a disheartening fact that patients are being diagnosed with cancer earlier but having children later—a trend that has made fertility preservation a key concern for the physicians who treat breast cancer (BC).

As the sun set on day 1 of the Miami Breast Cancer Conference, physicians gathered for the panel discussion, “Optimising Treatment Outcomes and Preserving Fertility in Premenopausal HR+ Breast Cancer.” 

Supporting patients who want to start a family

It starts with open dialogue, “right away,” says Rebecca Shatsky, MD, medical oncologist and Associate Professor of Medicine at UC San Diego Health. “Start discussing this at diagnosis—which can be overwhelming…but it is necessary, especially with our younger women," she says.

Because BC robs them of so much, so if there’s an opportunity for [fertility preservation], this is important.

Strategies for fertility preservation include embryo and oocyte cryopreservation, ovarian suppression with gonadotropin releasing hormone agonists, or GnRHa, (which protects the ovaries during chemotherapy), ovarian tissue suppression, and alternative family building options (like adoption).

“Thankfully, there are advances in fertility preservation that provide viable fertility treatment,” she continues. And that while it might be hard to process these words, “BC is rarely an emergency,”she says—meaning that the 10-14 days it might take for a woman to stimulate her ovaries and preserve her embryos can be done. “We have that time,” she says.

Advice for the clinic

Dr. Shatsky says it’s important for physicians to have a go-to provider in their community that they could send a newly diagnosed BC patient to with an urgent request for fertility care. “You can get their egg stimulation harvesting within 2 weeks if everything is done on a key timeline,” she says.

Michelle Taylor, RN, MSN, ANP-BC, a breast oncology nurse practitioner at Dignity Health Cancer Institute, says that ovarian suppression is common, especially in lower-income communities, as preservation can cost as much as $12,000. The panel also noted that ovarian tissue cryopreservation is an option—but it’s experimental and costly, with only a 40% success rate. But for patients who go the GnRHa route, she says, there are uncertain long-term benefits. “Insurance will cover a  GnRH agonist you can start before treatment to put the ovaries to sleep and minimise the risk.” That conversation needs to happen with every single patient under the age of 55, she says. “It’s important you do not count anyone out.”