Fertility communication and high-risk patients

Abstract

Women who have a high-risk family history of breast or ovarian cancer or carry deleterious genetic mutations develop these malignancies at a higher rate and younger age than the general population. Prophylactic interventions-including tamoxifen use and bilateral salpingo-oophorectomy-can reduce the risk of developing breast and ovarian cancer but are undertaken during reproductive years and may compromise young patients’ ability to have children. Thus, these young women-called “previvors”-face difficult decisions regarding the balance between preventive treatment and future childbearing and breastfeeding. Oncofertility may particularly benefit this group of women, by allowing them to take a proactive approach that integrates cancer prevention and fertility preservation concerns. In this chapter, we discuss when the issue of fertility might be raised during a high-risk consultation. We also present two case examples illustrating the importance of discussing fertility preservation with patients at high risk for developing breast or ovarian cancer.