Evaluating Trends in Fertility Counseling among Reproductive-Age Patients with Breast Cancer

Treatment-related infertility remains a paramount concern for young breast cancer patients. While emphasis on oncofertility is increasing, provision of fertility preservation remains suboptimal. This study evaluated oncofertility counseling (OC) and referral patterns to identify barriers to fertility preservation in this population.

A single-institution retrospective analysis was performed of women aged 40 years and younger with breast cancer from 2014 to 2024. Patient demographics, tumor and treatment characteristics, OC, referral to a reproductive endocrinologist (REI), and childbearing were evaluated.

Of 145 patients, 80 (55.2%) received OC, while 65 (44.8%) did not. Of those who received OC, 98.7% were counseled by their oncologist, compared with 23.4% who were counseled by their breast surgeon. Twenty-five women (31.7%) who received OC were referred to an REI, and 7 (29.2%) achieved childbearing. Patients who received OC were younger (35 vs. 38 years; p < 0.001) and nulliparous (45.0% vs. 18.5%; p = 0.001). Patients with advanced disease and who received neoadjuvant chemotherapy were more likely to receive OC (both p < 0.05). There was no difference in disease recurrence or survival between patients who received OC or referral to REI (p > 0.05).

OC is disproportionately provided to younger, nulliparous patients with advanced disease; however, all young breast cancer patients can benefit from OC, given the impact of cytotoxic and endocrine therapies on reproductive health. Breast surgeons' early role in the care of breast cancer patients offers an underutilized opportunity for OC. All providers should be prepared to discuss the impact of patients' diagnoses on fertility to maximize patient education and access to fertility preservation.