Disparities in the use of assisted reproductive technologies after breast cancer: a population-based study

• Published in: Breast cancer research and treatment 2023-02, Vol.198 (1), p.149-158
• Main Authors: Meernik, Clare, Jorgensen, Kirsten, Wu, Chi-Fang, Murphy, Caitlin C., Baker, Valerie L., Brady, Paula C., Nitecki, Roni, Nichols, Hazel B., Rauh-Hain, J. Alejandro
• Format: Article
• Language: English
• Subjects: Breast cancer; Breast Neoplasms - epidemiology; Breast Neoplasms - therapy; Cancer; Cancer research; Cohort Studies; Cryopreservation; Diagnosis; Embryo transfer; Epidemiology; Ethnicity; Female; Fertility; Fertility clinics; Hispanic people; Humans; Invasiveness; Medicine; Medicine & Public Health; Oncology; Oncology, Experimental; Population studies; Population-based studies; Pregnancy; Pregnancy Outcome; Reproductive Techniques, Assisted; Reproductive technologies; Reproductive technology; Survival; Technology application
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-022-06857-0

Purpose Equitable access to oncofertility services is a key component of cancer survivorship care, but factors affecting access and use remain understudied. Methods To describe disparities in assisted reproductive technology (ART) use among women with breast cancer in California, we conducted a population-based cohort study using linked oncology, ART, and demographic data. We identified women age 18–45 years diagnosed with invasive breast cancer between 2000 and 2015. The primary outcome was ART use—including oocyte/embryo cryopreservation or embryo transfer—after cancer diagnosis. We used log-binomial regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) to identify factors associated with ART use. Results Among 36,468 women with invasive breast cancer, 206 (0.56%) used ART. Women significantly less likely to use ART were age 36–45 years at diagnosis (vs. 18–35 years: PR = 0.17, 95% CI 0.13–0.22); non-Hispanic Black or Hispanic (vs. non-Hispanic White: PR = 0.31, 95% CI 0.21–0.46); had at least one child (vs. no children: adjusted PR [aPR] = 0.39, 95% CI 0.25–0.60); or lived in non-urban areas (vs. urban: aPR = 0.28, 95% CI 0.10–0.75), whereas women more likely to use ART lived in high-SES areas (vs. low-/middle-SES areas: aPR = 2.93, 95% CI 2.04–4.20) or had private insurance (vs. public/other insurance: aPR = 2.95, 95% CI 1.59–5.49). Conclusion Women with breast cancer who are socially or economically disadvantaged, or who already had a child, are substantially less likely to use ART after diagnosis. The implementation of policies or programs targeting more equitable access to fertility services for women with cancer is warranted.