Fertility Preservation,fertility concerns and Decision-Making in Breast Cancer Patients of Childbearing Age: A Cross-sectional Study

Abstract Background Breast cancer (BC) incidence in adults younger than 45 years is steadily increasing in China, raising concerns about the long-term quality of life for young survivors. As many of these patients are of reproductive age, treatment-related gonadotoxicity poses a significant threat to their future fertility.While fertility preservation (FP) options such as egg/embryo freezing or ovarian suppression exist, FP decision-making in BC patients remains inconsistent. Factors such as limited awareness, time constraints during cancer treatment, and conflicting medical advice may contribute to this variability. Understanding how fertility concerns influence FP choices is critical to improving patient-centered care. Purpose This study examines the association between fertility preservation choices and fertility-related concerns in BC patients, aiming to identify key factors that shape FP decision-making. Methods From February 2024 to June 2024,279 female BC patients were selected from the cancer centers of 3 tertiary Level A general hospitals in Hengyang cities of Hunan Province.The patients completed the Chinese version of the Reproductive Concerns After Cancer Scale(RCACS), the Decision Regret Scale(DRS), the Decision Conflict Scale(DCS), and the Decision Self-Efficacy Scale(DES).A binary logistic regression model was used to explore the relationships among FP choice,decision-making and fertility concerns. Result Correlation analyses revealed significant correlations( p < 0.01 ) with decision regret, decision conflict, and self-efficacy, but non-significant correlations( p = 0.306 ) with fertility concerns.However, binary logistic regression showed that FP choices were statistically significantly associated with decision regret (OR = 1.053, 95%CI 1.025–1.082, p < 0.05) as well as fertility concerns (OR = 0.95, 95%CI 0.921–0.981,p < 0.05).This suggests that the relationship between fertility protection and fertility concerns may be influenced by a combination of factors rather than a simple linear relationship. Conclusion Fertility preservation choices in young breast cancer patients are significantly influenced by decision psychological experience and fertility concerns.