e12685 Background: Approximately 12,000 women under 40 years are diagnosed with breast cancer annually in the US, representing 7% of all cases. Cancer-directed therapy may adversely impact fertility through chemotherapy-associated premature ovarian insufficiency and delays in childbearing related to prolonged endocrine therapy. ASCO guidelines recommend oncofertility assessment at diagnosis, including counseling on treatment-related reproductive risks and referral for fertility preservation (FP). Available FP methods (oocyte/embryo cryopreservation, ovarian tissue cryopreservation, and ovarian suppression) should be discussed prior to initiation of cancer-directed therapy. Despite established safety and efficacy of FP, barriers to care persist, including limited access to oncofertility counseling and FP services, as well as delays in chemotherapy initiation. We conducted a retrospective review to assess real-world oncofertility counseling practices over a 10-year period among adolescent and young adult (AYA) patients aged 15-39 with breast cancer. Methods: We conducted a retrospective cohort study of patients diagnosed with invasive breast cancer before age 40 from 2013-2023 at a tertiary medical center (n = 498). Exclusion criteria included male sex, stage IV disease, no receipt of chemotherapy, and absence of documented oncofertility counseling prior to systemic therapy. Oncofertility counseling practices and clinicodemographic variables (age, race, ethnicity, stage, and parity) were abstracted from the EMR. We performed univariate analyses to evaluate the associations between oncofertility counseling and clinicodemographic characteristics. Results: Of 281 women under 40 with stage I-III breast cancer who received chemotherapy, 132 (47%) had oncofertility counseling prior to therapy. Counseling rates were highest in the 20-25 age group (85%) and lowest in the 36-39 age group (30%). Counseling rates differed by parity (68% nulliparous, 48% one child, 30% ≥2 children; p < 0.001) but not by race/ethnicity (p=0.69). Among counseled patients, 67 (51%) expressed interest in FP, of whom 65% received a reproductive endocrinology (REI) referral and 70% received FP treatment. The most used FP strategy was GnRH agonist (61%), followed by oocyte/embryo cryopreservation (9%), and combined approaches (16%). Conclusions: Oncofertility counseling was associated with increased utilization of FP interventions. In our study, counseling rates varied significantly by parity, with nulliparous women more likely to receive counseling, while no significant differences were observed by race and ethnicity. Among counseled patients interested in FP, the majority received a referral to REI and proceeded with FP treatment. These findings underscore the importance of systematic integration of oncofertility counseling at diagnosis, prior to initiation of cancer therapy.
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