Abstract P4-04-15: Oncofertility and Breast Cancer: An Analysis of Perception and Practices Among Specialists

Abstract Introduction: Worldwide, breast cancer is considered the most common cancer among women, with advanced treatments improving survival chances. In this context, the importance of preserving fertility stands out, seen as an influencing aspect in the post-treatment quality of life for patients in reproductive age. This study aims to understand the perception of specialist doctors about oncofertility, addressing the barriers for its implementation and identifying areas for improvement. Methodology: This was an observational study, wich used an electronic questionnaire developed from literature review. The questionnaire was distributed to oncologists and breast specialists active in Brazil, through online platforms, aiming to evaluate knowledge about oncofertility, current practices, and barriers faced in preserving the fertility of breast cancer patients. Results: The questionnaire on oncofertility was answered by 276 Brazilian doctors, with a majority of 67.4% women and 63.3% doctors under 40 years old. The majority of them (78.6%) were specialists, with 70.7% of clinical oncologists, and 33.7% of doctors working in the oncology area for more than 10 years. Most doctors worked in the Southeast region (70.7%) and 52.9% worked in both public and private oncology centers. The patient's gestational desire was the main incentive to discuss fertility (43.8%). Regarding knowledge in oncofertility, 77.9% of doctors felt well informed about the subject, with specialists (81.6%) outnumbering residents (64.4%) in this aspect. Around 68.7% of the specialists stated that they usually consulted international guidelines related to the topic. Regarding fertility preservation practices, such as ovarian suppression with GnRHa and cryopreservation, 72.4% of specialists stated that they had knowledge on the subject, and 82.6% considered cryopreservation as the most effective method. In their practice, 77.9% of the interviewees reported addressing oncofertility, a fact that was more common among specialists (83.4%) compared to residents (57.6%). Among those who did not address it, 61 participants, the main barrier was the lack of access to fertilization techniques in public health (80.3%). The majority of specialists (86.6%) were not resistant to procedures that delay chemotherapy, and 98.9% denied personal barriers against fertility preservation. The cost of fertility preservation practices was considered high by 62.0% of the doctors, especially among residents (74.6%) versus specialists (58.5%). The structural distance from fertilization centers was considered a barrier for 24.3% of doctors. Regarding recommendations for young patients with gestational desire, 63.0% suggested ovarian suppression and/or cryopreservation as a possible modality of fertility preservation. Controlled ovarian stimulation was considered safe for all patients by 56.2% of the experts. Regarding the use of ovarian suppression with GnRH during chemotherapy, 70% of specialists described its use in practice. The majority of professionals (69.2%) did not consider pregnancy after cancer as a factor that increases the risk of recurrence, while 68.5% judged as safe the temporary interruption of endocrine treatment. Furthermore, 84.4% considered assisted reproduction techniques as safe options as well. Significant differences about the perception of pregnancy after cancer could be seen between residents and specialists. Among the experts, breast specialists and oncologists diverged in the safety of ovarian stimulation and in the indication for ovarian suppression. Opinions varied minimally by region of activity, highlighting the uniformity in the general view about treating oncofertility. Discussion: The results indicate a growing awareness about the importance of oncofertility, although there are significant challenges related to access and professional education. The majority of the interviewees showed knowledge about oncofertility, but there was a significant difference in knowledge between specialists and residents, indicating the need to integrate this topic into medical training curricula. Cryopreservation was considered the most effective method of fertility preservation, but challenges in its applicability include the structural distance from specialized fertilization centers and the lack of knowledge about current available techniques, especially in less developed regions. Although most professionals were willing to discuss fertility preservation strategies in their clinical practices, there were significant barriers, such as cost and the lack of adequate infrastructure. The study also highlights the importance of patients' gestational desire as a motivating factor for addressing fertility during oncological treatment. The research reveals the need to improve communication about fertility risks and available preservation options, in addition to addressing challenges related to cost and access to knowledge in oncofertility, suggesting that targeted educational strategies are necessary to promote informed and uniform practices. Conclusion This study highlights the importance of oncofertility in clinical practice for young patients with breast cancer, identifying significant barriers that need to be overcome in an underdeveloped country. Greater emphasis on physician education and improved access to fertility preservation techniques is recommended. Citation Format: Erika Bushatsky, Andressa Candido, Maria Eduarda Scheidt, Hector Gramulia, Cicilia Rodrigues, Renata Meneguetti. Oncofertility and Breast Cancer: An Analysis of Perception and Practices Among Specialists [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P4-04-15.