Early Oncofertility Counseling Needed for Young Patients With Breast Cancer: Yara Abdou, MD

Since fertility concerns influence treatment decisions for young women with breast cancer, fertility counseling is essential to ensure patients can engage in their care without feeling they are sacrificing a major part of their lives, Yara Abdou, MD, of the University of North Carolina at Chapel Hill, told The American Journal of Managed Care^® at the San Antonio Breast Cancer Symposium.

She also highlighted differences in the epidemiology and biology of breast cancer between younger and older patients, explaining how these distinctions affect treatment approaches, including fertility preservation.

Abdou expanded on these subjects in her presentation, "Special Management Considerations for Young Patients With Breast Cancer," delivered yesterday during the session, "Breast Cancer in Young Women—Biology, Treatment, and Ethics."

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

How do the epidemiology and biology of breast cancer in younger women differ from older patients, and what unique challenges does this create?

Breast cancer in young women has been, unfortunately, rising globally, and it certainly behaves a little differently than breast cancer in older women. In younger women, the tumor has a little more aggressive biological features—[it is] more proliferative, higher grade, and presents with more aggressive molecular subtypes, such as basal-like or HER2-enriched tumors.

Even with hormone [receptor]–positive breast cancer, we see more Luminal B tumors in young patients and higher genomic risk profiles in tumors from young patients. That translates into more intensive treatments in the clinic and more complex decision-making for young patients.

Given these differences, how do treatment approaches for younger patients compare with those for older patients?

Given the more aggressive biological features we see in young women with breast cancer, we tend to give more intensive treatment regimens for this population. However, it's important to emphasize that the core treatment principles don't necessarily change with age, so our treatment strategies are still driven by the tumor biology, the stage, and the genomic risk, just like we do with older patients.

What gets more complex here is integrating our oncologic goals with the lived reality of young women's lives, so balancing our treatments with fertility planning, psychosocial needs, and long-term quality-of-life trade-offs.

How do fertility preservation needs shape treatment planning, and how should clinicians effectively initiate this conversation with young patients?

Fertility concerns really shape treatment decisions for young women with breast cancer. In a young woman's breast cancer study, 1 in 5 young women actually changed their treatment altogether because of fertility concerns, whether it's declining chemo, altering the regimen, or shortening the endocrine therapy. Fertility counseling is not just nice to have; it's really essential if we want our young patients to engage in their treatment without feeling like they're sacrificing a big part of their lives.

When it comes to fertility counseling and preservation, the key message is timing. We need to counsel early, at the time of diagnosis, and refer for fertility preservation before any cancer-directed therapy, because once we start our cancer treatments, a lot of fertility options are no longer available. Our job as oncologists is to navigate those referrals and advocate for our patients with insurance coverage because financial toxicity remains a major barrier for a lot of these patients from getting fertility preservation.