Combined strategy for fertility preservation in an oncologic patient: vitrification of in vitro matured oocytes and ovarian tissue freezing (original) (raw)
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An update on the screening, diagnosis & management of breast cancer: A review with considerations for future fertility, 2021
The diagnosis along with management of Breast cancer(BC) are going through a prototype switch from the one size fitting all towards the period of individualized medicine. With the advances in diagnosis that is inclusive of sophisticated methods like molecular imaging in addition to genomic expression profile aid in enhancement of tumor characteristics to get unraveled. With these diagnostics, in combination with the newer surgical strategies in addition to radiation therapy cause a strategy that is inclusive of multiple disciplines cooperating with each other for reduction of recurrence to the utmost minimum. Here we conducted a review utilizing search engine pub-med, google scholar; web of science; embrace; Cochrane review library utilizing the MeSH terms like surgery; presence or absence of estrogen receptor(ER);progesterone receptor(PR); human epidermal growth factor receptor (HER2),; chemotherapy; triple negative breast cancer(TNBC); endocrine therapy; metastases; radio therapy; imaging modalities; causes of TNBC; drug resistance; prognosis; markers for TNBC; effective tamoxifen; negative neo adjuvant chemotherapy; gene markers; role of microRNAs, from 1980's till august 2021.We found a total of 442800 articles out of which we selected 86 articles for this chapter on update on breast cancer management. No meta-analysis was done. Further we have tried to explore a lot of modes by which TNBC treatment success can get escalated inclusive of the newer utilization of H2S pathway in cancer as well as mode by which it might work. Further with the escalated 5 yr survival along with advances in ovarian tissue cryopreservation oocyte cryopreservation prior to chemotherapy as well as radiotherapy one can consider ovarian tissue transplantation in such cases. With BCS an attempt at cosmetic surgery aids in women leading a more normal life. Thus we have tried to comprehensively detail all these features.
Fertility preservation in women with breast cancer
2010
Fertility preservation is an important issue for young women diagnosed with breast cancer. The most well-established options for fertility preservation in cancer patients, embryo and oocyte cryopreservation, have not been traditionally offered to breast cancer patients as estradiol rise during standard stimulation protocols may not be safe for those patients. Potentially safer stimulation protocols using tamoxifen and aromatase inhibitors induce lower levels of estradiol while similar results in terms of number of oocyte and embryo obtained to standard protocols. Cryopreservation of immature oocytes and ovarian cortical tissue, both still experimental methods, are also fertility preservation options for breast cancer patients.
Advances in the Treatment of Breast Cancer Emphasis on fertility preservation A Case Report
Advances in the Treatment of Breast Cancer-Emphasis on fertility preservation- A Case Report, 2017
With the recent advances in breast cancer treatment the 5 year survival rates have increased significantly with overall 20yrs survival in developed countries like USA. With further improvement being designed in the treatment of breast cancers with more and more sophisticated models to study breast cancer in human beings using the modern microfluidic models one expects more and younger breast cancer survivors to be needing fertility treatments. Here we review the modern advances in breast cancer treatments and the need for emphasizing on fertility preservation before starting any chemotherapeutic or other management as recommended by both ASO and ASRM. We further discuss the methods of fertility preservation in such young breast cancer patients or models without affecting there 5 years survivals we further report a case of HER2 positive breast cancer patient receiving multiple chemotherapeutic agents followed by radiotherapy where such treatment was not even discussed in a patient of primary infertility before starting treatment like chemotherapy and radiotherapy even in a developing country where cryopreservation of embryos or oocytes was possible just before the treatment if not preserving the ovarian tissue .
Management of young women with early breast cancer – focus on fertility preservation
Libri oncologici, 2019
Management of young women with breast cancer is complex and has several particularities, one of which is fertility preservation, a very important quality of life issue for young breast cancer survivors. Chemotherapy can be gonadotoxic and signifi cantly reduce woman`s reproductive potential and cause premature ovarian insuffi ciency while endocrine therapy requires a delay of pregnancy and indirectly aff ects fertility. Therefore every woman of reproductive age diagnosed with breast cancer should be informed about potential gonadotoxic eff ect of cancer treatment, the risk of premature ovarian insuffi ciency and associated symptoms, available fertility preservation methods, delay of cancer treatment and chances of subsequent pregnancy. If interested in fertility preservation breast cancer patients should be referred as early as possible to a reproductive specialist to further discuss the risk of infertility and available fertility preservation options. Currently established methods for fertility preservation are embryo and oocyte cryopreservation, while ovarian tissue cryopreservation, cryopreservation of immature oocytes and ovarian suppression with gonadotropin-releasing hormone agonists are still considered experimental. The aim of this review is to highlight the importance of fertility preservation as an important quality of life issue for young breast cancer survivors.
Frontiers in Medicine, 2021
Breast cancer comprised at least 21.8% of the overall cancer among young adult (YA) women and became the leading cancer in this group in Japan, with 50% adolescent and YAs being diagnosed and 15–44-year-old women showing excellent 5-year survival. Surgical-chemoradiation therapy often results in excellent survivorship with an increased incidence of treatment-induced subfertility. Therefore, adding fertility preservation (FP) to the primary cancer treatment is necessary. Herein, we reported a series of cases of YA women with breast cancer who opted for FP, where their option was tailored accordingly. To date, the selection of oocytes, embryos and ovarian tissue is widely available as an FP treatment. PGT could reduce the risk of BRCA mutation transmission amongst BRCA carriers before pregnancy planning. Otherwise, gonadotropin-releasing hormone analog has no gonadoprotective effect and thus should not be considered as an FP option.
Fertility Issues in Young Patients with Breast Cancer
Indian Journal of Gynecologic Oncology, 2018
Objective To review the need for fertility preservation in young patients with breast cancer. Materials and Methods This retrospective study includes patients B 40 years with breast carcinoma treated at Action Cancer Hospital, New Delhi, from June 2010 to 31 July 2014. Patient age, marital status, parity, contraception use, and the need for fertility preservation were evaluated. Result Fifty-three patients were included in study with mean age 35.4 (SD: 4.1) years. Fifty (94.3%) patients were married, and four (7.5%) were nulliparous. All had regular menstrual cycles before treatment except one who had premature menopause. Thirty (56.6%) patients had used some form of contraception. Forty-eight patients underwent modified radical mastectomy, and five patients had breast conservative surgery. Most common histopathology was infiltrating duct carcinoma in fifty (94.3%) patients. Tumor was hormone responsive in twenty-four (45.3%) cases and triple negative in twenty one (39.6%) cases. Neo-adjuvant chemotherapy was given in four (7.5%) patients, adjuvant chemotherapy was given in fifty-one (96.2%) patients, thirty-three (62.3%) patients received adjuvant radiotherapy, and adjuvant hormone therapy was received by thirty-one (58.5%) patients. None of these patients were counseled regarding their fertility concerns, none was referred to oncofertility specialist before starting the treatment, and none was investigated for their future fertility prospects. No one was aware of fertility preservation methods. Fertility was desired by only nine (17%) patient at the time of diagnosis out of which four were nulliparous and five patients had single live issue. Conclusion In India, most women get married at early age and complete their family early. However, few patients are unable to complete their family at the time of diagnosis of breast cancer and need fertility preservation. Oncofertility counseling is of great importance to many young women diagnosed with cancer and should be managed in a multidisciplinary background. All options of fertility preservation should be discussed with them before starting treatment.
Breast cancer and fertility preservation
Fertility and Sterility, 2011
Objective-To review the benefits of adjuvant systemic therapy given to women with breast cancer of reproductive age, its effects on fertility, and options for fertility preservation. Design-Publications relevant to fertility preservation and breast cancer were identified through a PubMed database search. Conclusion(s)-Most women who develop invasive breast cancer under age 40 will be advised to undergo adjuvant chemotherapy with or without extended antihormonal therapy to reduce the risk of recurrence and death from breast cancer. Adjuvant chemotherapy particularly with alkylating agents such as cyclophosphamide is gonadotoxic and markedly accelerates the rate of age-related ovarian follicle loss. Although loss of fertility is an important issue for young cancer survivors, there is often little discussion about fertility preservation before initiation of adjuvant therapy. Greater familiarity with prognosis and effects of different types of adjuvant therapy on the part of infertility specialists and fertility preservation options such cryopreservation of embryos, oocytes, and ovarian tissue on the part of oncologists would facilitate these discussions. Establishment of rapid fertility consultation links within cancer survivorship programs can help ensure that every young woman who is likely to undergo gonadotoxic cancer treatment is counseled about the effects of therapy and options available to her to increase the likelihood of childbearing after cancer treatment.
Frontiers in Oncology, 2021
Background: Offering ovarian function and/or fertility preservation strategies in premenopausal women with newly diagnosed breast cancer candidates to undergo chemotherapy is standard of care. However, few data are available on uptake and main reasons for refusing these options. Methods: The PREFER study (NCT02895165) is an observational, prospective study enrolling premenopausal women with early breast cancer, aged between 18 and 45 years, candidates to receive (neo)adjuvant chemotherapy. Primary objective is to collect information on acceptance rates and reasons for refusal of the proposed strategies for ovarian function and/or fertility preservation available in Italy. Results: At the study coordinating center, 223 patients were recruited between November 2012 and December 2020. Median age was 38 years (range 24-45 years) with 159 patients (71.3%) diagnosed at ≤40 years. Temporary ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) was accepted by 58 out of 64 (90.6%) patients aged 41-45 years and by 151 out of 159 (95.0%) of those aged ≤40 years. Among patients aged ≤40 years, 57 (35.8%) accepted to access the fertility unit to receive a complete oncofertility counseling and 29 (18.2%) accepted to undergo a cryopreservation technique. Main reasons for refusal were fear of delaying the initiation of antineoplastic treatments and contraindications to the procedure or lack of interest in future childbearing. Patients with hormone-receptor positive breast cancer had a