TY - JOUR
T1 - Disparities in the use of assisted reproductive technologies after breast cancer
T2 - a population-based study
AU - Meernik, Clare
AU - Jorgensen, Kirsten
AU - Wu, Chi Fang
AU - Murphy, Caitlin C.
AU - Baker, Valerie L.
AU - Brady, Paula C.
AU - Nitecki, Roni
AU - Nichols, Hazel B.
AU - Rauh-Hain, J. Alejandro
N1 - Funding Information:
This work was supported by grants from the National Cancer Institute at the National Institutes of Health (K08 CA234333, to JARH; P30 CA016672, to KJ, RN, and JARH; T32 CA101642, to KJ and RN; and F31 CA260787, to CM); and the U.S. Department of Defense (CA181215 to CCM). The funding sources were not involved in the development of the research hypothesis, study design, data analysis, or manuscript writing. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding Information:
The authors thank SART for the dataset, as well as all SART members for providing clinical information to the SART CORS database for use by patients and researchers. Without the efforts of SART members, this research would not have been possible. We thank Joe Munch in MD Anderson’s Research Medical Library for editing the manuscript.
Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2023/2
Y1 - 2023/2
N2 - 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.
AB - 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.
KW - Assisted reproductive technology
KW - Breast cancer
KW - Disparities
KW - Fertility preservation
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U2 - 10.1007/s10549-022-06857-0
DO - 10.1007/s10549-022-06857-0
M3 - Article
C2 - 36607486
AN - SCOPUS:85145730154
SN - 0167-6806
VL - 198
SP - 149
EP - 158
JO - Breast Cancer Research and Treatment
JF - Breast Cancer Research and Treatment
IS - 1
ER -