Determinants of access to fertility preservation in women with breast cancer

ObjectiveTo evaluate socioeconomic, demographic, and medical factors that influence the referral pattern—either before cancer treatment for fertility preservation (FP, early referral) or post-chemotherapy for assisted reproductive technology (PCART, delayed referral)—in women with breast cancer.DesignSecondary analysis.SettingAcademic medical centers.Patient(s)Three hundred fourteen patients with breast cancer who were counseled for FP (n = 218) or PCART (n = 96) from June 1999 to July 2009.Intervention(s)None.Main Outcome Measure(s)Factors favoring early referrals.Result(s)Mean age at diagnosis was higher in FP vs. PCART (35.3 ± 4.5 years vs. 33.9 ± 4.7 years). Ninety percent presented with cancer stage 1 or 2. From 2000 to 2009 the proportion of referrals for FP increased continually. In 2009, nearly all (95.5%) were for FP. The majority (63.8%) was referred from an academic center. Patients with a family history of breast cancer were more likely to consult for FP (75.2% vs. 64.3% without). There was no association with occupation, income, race, ethnicity, obstetric history, and prior infertility treatment. Only 22.9% of those counseled in PCART, compared with 45.0% in the FP group, proceeded with a procedure.Conclusion(s)There has been an increasing trend within the last 10 years for early referral of breast cancer patients to FP. Factors favoring early referrals are older age, early-stage cancer, family history of breast cancer, and academic center involvement. Those seen before cancer treatment are more likely to receive an intervention.