Use of tamoxifen by young women is influenced by fertility concerns

The risk of breast cancer recurrence and mortality is decreased by endocrine therapy (ET) such as tamoxifen, but younger patients may decline it or discontinue treatment early if they are concerned about fertility, according to a study published August 24 in the JNCI: Journal of the National Cancer Institute.

To explore the reasons for lower initiation and continuation with tamoxifen treatment by younger women with breast cancer, Jacqueline S. Jeruss M.D., Ph.D. of The University of Michigan School of Medicine, Ann Arbor, MI and colleagues conducted a study of 515 premenopausal patients, younger than age 45, with stage 0-III hormone receptor-positive breast cancer for whom tamoxifen was recommended. Demographic, disease, and treatment data, as well as patient concerns, were obtained from chart review. Patients who did not initiate or discontinued tamoxifen treatment were also interviewed by telephone.

Women who received a diagnosis of ductal carcinoma in situ, declined radiation therapy, did not receive chemotherapy, had a history of smoking, or had fertility concerns were less likely to initiate or more likely to discontinue tamoxifen treatment early. The primary reasons that patients gave for not initiating, delaying, or discontinuing treatment were concerns about side effects and the ability to become pregnant.

The researchers write "Despite the importance of fertility to young breast cancer patients, availability of fertility preservation options, and relative safety of pregnancy among breast cancer survivors, fertility preservation is often underutilized and under-discussed in clinical settings."

In an accompanying editorial, Shoshana M. Rosenberg, Sc.D., M.P.H., and Ann H. Partridge, M.D., M.P.H., of the Dana-Farber Cancer Institute, Boston, MA, write that these results "...not only shed new light on the role of side effects and concern about side effect on non-adherence in young women, but also draw attention to the impact of fertility concerns on adjuvant ET decision-making." They comment that although the retrospective nature of the study limits its generalizability, "Further understanding of patterns of non-adherence and non-persistence in young women...may ultimately lead to more targeted and timely interventions to improve adherence to therapy."

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Article: Jacqueline S. Jeruss, M.D., Ph.D.; jjeruss@med.umich.edu

Editorial: Ann H. Partridge, M.D., M.P.H., ann_partridge@dfci.harvard.edu