ABSTRACT: Nearly 10% of cancer cases occur in women of reproductive age. Because most will survive 5 years or more, reproductive health and fertility concerns are of great importance to these women. Treatment with cytotoxic drugs and radiation has teratogenic and mutagenic properties and can adversely affect the pregnancy. Moreover, pregnancy itself can impact the course of a patient’s cancer. Few data exist to guide practitioners on when and how to counsel female cancer patients on their risk of unintended pregnancy, the optimal timing of conception, and contraceptive methods.
The aims of this retrospective study were to describe contraceptive methods used by female cancer survivors and to determine whether pretreatment fertility counseling decreases the risk of unintended pregnancy. Study subjects were survivors of nongynecologic cancer between18 and 40 years of age who had responded to a survey on use of fertility preservation methods and contraceptive methods, as well as fertility counseling before treatment. Participants who had resumed menstrual bleeding, had not undergone surgical sterilization, and did not wish to conceive were considered to be at risk of unintended pregnancy if they had unprotected vaginal intercourse in the previous month. Statistical analysis was performed using x2 and Student t test.
Of the 2532 women asked to participate, 1041 (41%) completed the survey. A total of 918 women (88%) received treatment (chemotherapy, radiation, or sterilizing surgery) with potential to compromise fertility. The final analysis included 476 women younger than 40 years who were still menstruating. Twenty-one percent (58/275) of the women who did not want to conceive reported unprotected intercourse in the previous month and were at risk of unintended pregnancy. This compared with the 7.3% risk of unintended pregnancy in the general population reported by the National Center for Health Statistics. Methods of contraception used by the participants after treatment resembled those used by the general population. Sixty-seven percent (293/476) of the women received pretreatment fertility counseling. However, counseling prior to treatment was not associated with a decreased risk of unintended pregnancy (P = 0.93).
These data show that 21% of sexually active cancer survivors are at risk of unintended pregnancy, a nearly 3-fold increased risk relative to the general population. Fertility counseling prior to treatment was not associated with reduce risk of unintended pregnancy, demonstrating the need for clear recommendations on content and timing of counseling.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA (M.M.Q., M.P.R.); and Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC (J.M.L.)