Women not preserving fertility during cancer treatment

A new study from the US finds few young women being treated for cancer take steps to preserve their fertility, for instance so they can start a family later. Dr Mitchell Rosen, of the University of California, San Francisco (UCSF), and colleagues, also found disparities among different groups of young women, with some more likely to take steps to freeze eggs or embryos than others. Writing in the 26 March early online view of the journal Cancer, the researchers say their findings show there is a need to boost provisions of counseling on fertility preservation to women of reproductive age undergoing cancer treatment. Rosen told the press: "Although more women are getting counseled regarding reproductive health risks, many women are still not receiving adequate information about their options at the time of cancer diagnosis." More than 120,000 women under the age of 50 are diagnosed with cancer every year in the US, where, as survival rates improve daily, concerns turn to quality of life post-cancer. Many chemotherapy and other cancer treatments can leave a woman infertile or bring on early menopause, and should this happen she may regret losing her ability to have children. But, with techniques like egg or embryo freezing more widely available than ever, women who have been diagnosed with cancer do have the option to improve their chances of conceiving again later. To establish which women are taking advantage of these fertility preservation options, Rosen and colleagues surveyed women who had been diagnosed with cancer between the ages of 18 and 40 years, who were registered in the California Cancer Registry between 1993 and 2007. The survey asked questions about acute ovarian failure, early menopause (before the age of 45), and failed conception. The researchers focused on five cancer types: leukemia, Hodgkin's disease, Non-Hodgkin Lymphoma, breast cancer, and gastrointestinal cancer. A total of 1,041 women responded to the survey, of which 918 had received treatments that could affect their fertility, such as chemotherapy, pelvic radiation, pelvic surgery, and bone marrow transplant. The researchers examined the relationships between age, gender, ethnicity, and other sociodemographic characteristics and the odds of using fertility preservation services. They found that 61% of the women received counseling on the risks that cancer treatment can have on their fertility from their doctor or other clinician. Overall, only 4% of women took up the option of fertility preservation, although rates showed a tendency to increase over time. For example, in 1993, the take up rate was 1%, whereas in 2005 to 2007 it was between 6% and 10%. Rosen said: "Routine counseling regarding reproductive health risk and options for preserving reproductive potential will improve the quality of life among survivors, and the overall quality of care." The researchers also found that certain groups were more likely to receive information about their reproductive health when they were diagnosed with cancer, and also more likely to take steps to preserve their fertility, than other groups. The women most likely to receive counseling about the effects of cancer treatment on their fertility, and also most likely to preserve fertility beforehand, were younger, Caucasian, childless, heterosexual, and college educated. Rosen and colleagues conclude that disparities in sociodemographic health characteristics likely affect women's access to fertility preservation services. "An opportunity lies ahead to explore educational and policy interventions to ameliorate health disparities that may exist in the growing use of fertility preservation," said Rosen.