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Practice Point
Fertility considerations – Referral
Discuss fertility issues and the implications of premature menopause with all premenopausal women. Arrange early referral to a fertility specialist to maximise the opportunity for consideration of fertility preservation if appropriate and feasible.
Fertility issues should always be discussed before the start of any breast cancer therapy. Discussion should allow appropriate time for reflection and should possibly involve the partner, if present. An early referral to the reproductive endocrinologist is warranted
All young women should be counselled, before the onset of systemic therapy (either CT or ET), about the risks, associated symptoms and outcomes of treatment-related amenorrhea and premature menopause, referred for special fertility counselling/consultation and informed of available and approved ameliorative therapies.
We have limited confidence that the estimate of effect lies close to the true effect for this outcome. The body of evidence has major or numerous deficiencies (or both). We believe that additional evidence is needed before concluding either that the findings are stable or that the estimate of effect is close to the true effect
Appropriate to consider and discuss fertility and family planning with premenopausal women before they undergo breast cancer treatment
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How this guidance was developed
No evidence-based source recommendation was identified for this topic, which was considered an important aspect of care. This practice point was developed using an expert consensus process. Development of this guidance was informed by a source recommendation in the EUSOMA 2012 recommendations for breast cancer in young women (Europe) based on a non-systematic review of the evidence and that was graded as ‘low’ (using AHRQ methods) by the source guideline authors. It is also informed by a source recommendation in the ESO-ESMO 2017 and 2020 guidelines for breast cancer in young women (Europe) graded as ‘Expert Opinion’ by the source guideline authors, and which specifically indicates counselling before the onset of systemic therapy.
This recommendation aligns with the 2017 Cancer Australia Statement – Influencing best practice in breast cancer: Practice 3.
Related guidance by topic
Fertility considerations – Referral
Practice Point
Discuss fertility issues and the implications of premature menopause with all premenopausal women. Arrange early referral to a fertility specialist to maximise the opportunity for consideration of fertility preservation if appropriate and feasible.
Principles in action
Patient-centred care
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Safe and quality care
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Supportive care
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No evidence-based source recommendation was identified for this topic, which was considered an important aspect of care. This practice point was developed using an expert consensus process. Development of this guidance was informed by a source recommendation in the EUSOMA 2012 recommendations for breast cancer in young women (Europe) based on a non-systematic review of the evidence and that was graded as ‘low’ (using AHRQ methods) by the source guideline authors. It is also informed by a source recommendation in the ESO-ESMO 2017 and 2020 guidelines for breast cancer in young women (Europe) graded as ‘Expert Opinion’ by the source guideline authors, and which specifically indicates counselling before the onset of systemic therapy.
This recommendation aligns with the 2017 Cancer Australia Statement – Influencing best practice in breast cancer: Practice 3.
Related guidance by topic
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Reproductive and sexual health
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