Available Guidelines on Fertility Preservation of Young Patients with Breast Cancer; A Critical Appraisal

Owing to steady progress in oncology, survival rate of young patients with breast cancer isimproving. Fertility of these patients can be impaired through gonadotoxic effects ofaggressive chemotherapy or radiotherapy regimens. Since fertility is considered as one of themajor long-term quality-of-life determinants, fertility preservation has become ever moreimportant to the growing number of young breast cancer survivors. This study aimed tocritically appraise all available guidelines for fertility preservation in young breast cancerpatients. Major citation databases were searched for treatment guidelines. Availableguidelines were appraised by experts from relevant disciplines of medical oncology,epidemiology, cancer surgery and assisted-reproductive technology. The AGREE IIInstrument that includes 23 criteria in 7 domains (the scope and purpose of the guidelines,stakeholder involvement, rigor of development, clarity, applicability, editorial independence,and overall quality) were used to apprise and score the guidelines. The search strategyretrieved 2606 citations, of which 72 were considered for full-text screening and 7 guidelines(ASCO, EUSOMA, ISFP (Specific And General), NCCN, FertiPROTEKT, St Gallen wereincluded in the study. There wasvariability in the scores assigned to different domains amongthe guidelines. ASCO (2013) with an overall score of 68.0% had the highest score and StGallen with 24.7% score had the lowest scores among the guidelines. With the favoringsurvival rate among breast cancer patients, more attentions have to be given to includespecific fertility preservation recommendation in young breast cancer patients.

Keywords:

Fertility Preservation , Breast Cancer , Young Women , Practice Guidelines , Critical Appraisal