Tailored care in fertile women with cancer

Fertility can be at risk in female adolescents and young adults (AYAs) undergoing cancer treatment. Counseling about these risks and discussing fertility preservation options is highly recommended. Our study, using patient-reported measurements, indicates that current counseling needs improvement and clinical guideline adherence should be optimized.
To AYAs with gynecological cancer, fertility-sparing surgery (FSS) could be offered. Our systematic review shows FSS seems oncologically safe in early-stage and low-grade disease. However, evidence is based on retrospective and heterogeneous studies, highlighting the need for prospective registration to improve counseling.
Adenocarcinoma in situ of the cervix can be treated by FSS using either large loop excision of the transformation zone or cold-knife conization, as an alternative to a hysterectomy. Guidelines are inconsistent in their recommendations for the best treatment strategy. Our study showed that both FSS methods can be considered safe and final treatment modalities, when a radical excision is achieved. After FSS for cervical cancer, the optimal follow-up strategy is unknown. We demonstrated that follow-up can be tailored based on cervical cytology and high-risk human papillomavirus (HPV) testing.
AYAs with breast cancer might need adjuvant treatment with tamoxifen, which is often considered contraindicated during pregnancy due to potential teratogenicity. In our review, we found a low level of evidence on fetal adverse effects, suggesting that shared decision making is essential rather than presenting tamoxifen as absolutely contraindicated during pregnancy.
In case of cancer during pregnancy, chemotherapy might be indicated, which can potentially impair future fertility. Despite physiological ovarian function suppression during gestation, our experimental study in pregnant mice demonstrates chemotherapy-induced damage to maternal ovaries.