e13565 Background: As survival improves for reproductive-age women with breast cancer (BC), fertility preservation (FP) is a key component of high-quality oncologic care. ASCO and ASRM guidelines recommend early counseling and timely referral prior to gonadotoxic therapy; however, real-world FP delivery remains inconsistent. Prior studies often evaluate FP as a single outcome, limiting insight into where attrition occurs. We conducted a systematic review to map disparities across the FP continuum of counseling, referral, and utilization. Methods: We systematically reviewed observational studies evaluating FP among reproductive-age women with BC. Eligible studies reported rates of fertility counseling, referral to reproductive specialists, and/or FP utilization. Data were extracted without imputation or pooling. Disparities by race/ethnicity, socioeconomic status, insurance type, and geography were summarized. Given heterogeneity in outcome definitions, quantitative synthesis was restricted to studies with extractable denominators or adjusted estimates. Results: Four observational studies met inclusion criteria. Fertility counseling was reported in one institutional cohort, with 40 of 248 patients (≈16%) receiving counseling. Referral to fertility specialists was evaluated in one population-based study, with 178 of 4,452 patients referred (≈4.0%), demonstrating regional variation. FP utilization was reported in three studies and remained uniformly low, ranging from 0.6% in a large population-based cohort (206/36,468) to 3–4% in institutional cohorts (10/248 and 20/627). Across studies, non-Hispanic Black and Hispanic patients consistently demonstrated lower FP utilization than non-Hispanic White patients (adjusted prevalence ratio 0.31, 95% CI 0.21–0.46). Lower socioeconomic status, public insurance, and non-urban residence were also associated with reduced utilization. In contrast, associations between race or insurance status and counseling were weaker and inconsistent. Conclusions: Despite guideline endorsement, FP delivery in young women with BC demonstrated substantial attrition across the care continuum, with the greatest inequities occurring at utilization rather than counseling. These findings indicate that informational interventions alone are insufficient. Policy driven solutions including standardized referral mandates, insurance reform, and integrated oncology-reproductive care models are urgently needed to ensure equitable access to FP as a standard component of cancer care. Fertility preservation outcomes among young women with breast cancer. Outcome Study Events / N Observed Proportion Counseling Swain 2023 40 / 248 ~16% Referral Korkidakis 2019 178 / 4,452 ~4.0% Utilization Swain 2023 10 / 248 ~4.0% Utilization Mannion 2024 20 / 627 ~3.2% Utilization Meernik 2023 206 / 36,468 ~0.6%
Sangaraju et al. (Thu,) studied this question.
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