Prospective Study of Fertility Preservation in Young Women With Breast Cancer in Mexico
Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico;
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Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico;
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Departamento de Tumores Mamarios e Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico;
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Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico;
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Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico;
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Departamento de Tumores Mamarios e Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico;
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Departamento de Tumores Mamarios e Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico;
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Unidad de Epidemiologia e Investigacion Biomedica en Cancer, Instituto Nacional de Cancerologia, and
Instituto de Biomedicas, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, México
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Departamento de Tumores Mamarios e Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico;
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Background: Despite the risk of treatment-related infertility, implementation of fertility-preservation (FP) strategies among young patients with breast cancer is often suboptimal in resource-constrained settings such as Mexico. The “Joven & Fuerte: Program for Young Women With Breast Cancer” strives to enhance patient access to supportive care services, including FP measures through alliances with assisted-reproduction units and procurement of coverage of some of these strategies. This study describes patients from Joven & Fuerte who have preserved fertility, and assesses which characteristics were associated with the likelihood of undergoing FP. Methods: Women aged ≤40 years with recently diagnosed breast cancer were prospectively accrued. Sociodemographic and clinicopathologic data were collected from patient-reported and provider-recorded information at diagnosis and 1-year follow-up. Descriptive statistics, chi-square test, and simple logistic regression were used to compare patients who preserved fertility with those who did not. Results: In total, 447 patients were included, among which 53 (12%) preserved fertility, representing 38% of the 140 women who desired future biologic children. Oocyte/embryo cryopreservation was the most frequently used method for FP (59%), followed by temporary ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) during chemotherapy (26%), and use of both GnRHa and oocyte/embryo cryopreservation (15%). Younger age, higher educational level, being employed, having private healthcare insurance, and having one or no children were associated with a significantly higher likelihood of preserving fertility. Conclusions: By facilitating referral and seeking funds and special discounts for underserved patients, supportive care programs for young women with breast cancer can play a crucial role on enhancing access to oncofertility services that would otherwise be prohibitive because of their high costs, particularly in resource-constrained settings. For these efforts to be successful and widely applied in the long term, sustained and extended governmental coverage of FP options for this young group is warranted.
Submitted May 5, 2020; revision received October 31, 2020; accepted for publication November 30, 2020. Published online June 21, 2021.
Author contributions: Study concept and design: Villarreal-Garza, Plata de la Mora, Miaja-Avila, García Garza, Mohar, Bargallo-Rocha. Material preparation: Mesa-Chavez, Garcia-Garcia, Fonseca, de la Rosa-Pacheco, Cruz-Ramos. Data acquisition: Mesa-Chavez, Garcia-Garcia, Fonseca, de la Rosa-Pacheco, Cruz-Ramos. Data analysis and interpretation: Mesa-Chavez, Garcia-Garcia, Fonseca, de la Rosa-Pacheco, Cruz-Ramos. Manuscript preparation: Villarreal-Garza, Mesa-Chavez, Garcia-Garcia. Critical revision: All authors. Final approval of manuscript: All authors.
Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
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