Fertility preservation in women with breast cancer: challenges and opportunities.

This important and timely review by Dr. Munster effectively highlights the complexity of addressing fertility-related issues and fertility preservation in young women with breast cancer. Given the lack of long-term data, we are often left with more questions than answers about determining the appropriate management of these patients. Caring for women with estrogen receptor–positive tumors and BRCA mutations can add additional complexity. Women with hormone receptor–positive tumors face years of estrogen deprivation and/or endocrine therapy that is contraindicated during pregnancy. BRCA mutation carriers may also consider risk-reducing surgeries to decrease the risk of second breast cancers or to prevent ovarian cancers, thus further limiting fertility potential. In considering fertility issues in breast cancer patients, we must also contemplate the available data regarding the safety of pregnancy after breast cancer, the effects of breast cancer treatment on fertility, and how these effects impact women’s ability to cope with their diagnosis and their survivorship. This intersection of oncology and reproductive endocrinology will provide greater coordination of care and offer even more opportunities for our patients to pursue fertility options along with their cancer care.