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      Cancer and fertility preservation: international recommendations from an expert meeting

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          Abstract

          In the last years, thanks to the improvement in the prognosis of cancer patients, a growing attention has been given to the fertility issues. International guidelines on fertility preservation in cancer patients recommend that physicians discuss, as early as possible, with all patients of reproductive age their risk of infertility from the disease and/or treatment and their interest in having children after cancer, and help with informed fertility preservation decisions. As recommended by the American Society of Clinical Oncology and the European Society for Medical Oncology, sperm cryopreservation and embryo/oocyte cryopreservation are standard strategies for fertility preservations in male and female patients, respectively; other strategies (e.g. pharmacological protection of the gonads and gonadal tissue cryopreservation) are considered experimental techniques. However, since then, new data have become available, and several issues in this field are still controversial and should be addressed by both patients and their treating physicians.

          In April 2015, physicians with expertise in the field of fertility preservation in cancer patients from several European countries were invited in Genova (Italy) to participate in a workshop on the topic of “cancer and fertility preservation”. A total of ten controversial issues were discussed at the conference. Experts were asked to present an up-to-date review of the literature published on these topics and the presentation of own unpublished data was encouraged. On the basis of the data presented, as well as the expertise of the invited speakers, a total of ten recommendations were discussed and prepared with the aim to help physicians in counseling their young patients interested in fertility preservation.

          Although there is a great interest in this field, due to the lack of large prospective cohort studies and randomized trials on these topics, the level of evidence is not higher than 3 for most of the recommendations highlighting the need of further research efforts in many areas of this field. The participation to the ongoing registries and prospective studies is crucial to acquire more robust information in order to provide evidence-based recommendations.

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          Most cited references143

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          Tailoring therapies—improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015

          The 14th St Gallen International Breast Cancer Conference (2015) reviewed new evidence on locoregional and systemic therapies for early breast cancer. This manuscript presents news and progress since the 2013 meeting, provides expert opinion on almost 200 questions posed to Consensus Panel members, and summarizes treatment-oriented classification of subgroups and treatment recommendations.
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            Endogenous sex hormones and breast cancer in postmenopausal women: reanalysis of nine prospective studies.

            Reproductive and hormonal factors are involved in the etiology of breast cancer, but there are only a few prospective studies on endogenous sex hormone levels and breast cancer risk. We reanalyzed the worldwide data from prospective studies to examine the relationship between the levels of endogenous sex hormones and breast cancer risk in postmenopausal women. We analyzed the individual data from nine prospective studies on 663 women who developed breast cancer and 1765 women who did not. None of the women was taking exogenous sex hormones when their blood was collected to determine hormone levels. The relative risks (RRs) for breast cancer associated with increasing hormone concentrations were estimated by conditional logistic regression on case-control sets matched within each study. Linear trends and heterogeneity of RRs were assessed by two-sided tests or chi-square tests, as appropriate. The risk for breast cancer increased statistically significantly with increasing concentrations of all sex hormones examined: total estradiol, free estradiol, non-sex hormone-binding globulin (SHBG)-bound estradiol (which comprises free and albumin-bound estradiol), estrone, estrone sulfate, androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and testosterone. The RRs for women with increasing quintiles of estradiol concentrations, relative to the lowest quintile, were 1.42 (95% confidence interval [CI] = 1.04 to 1.95), 1.21 (95% CI = 0.89 to 1.66), 1.80 (95% CI = 1.33 to 2.43), and 2.00 (95% CI = 1.47 to 2.71; P(trend)<.001); the RRs for women with increasing quintiles of free estradiol were 1.38 (95% CI = 0.94 to 2.03), 1.84 (95% CI = 1.24 to 2.74), 2.24 (95% CI = 1.53 to 3.27), and 2.58 (95% CI = 1.76 to 3.78; P(trend)<.001). The magnitudes of risk associated with the other estrogens and with the androgens were similar. SHBG was associated with a decrease in breast cancer risk (P(trend) =.041). The increases in risk associated with increased levels of all sex hormones remained after subjects who were diagnosed with breast cancer within 2 years of blood collection were excluded from the analysis. Levels of endogenous sex hormones are strongly associated with breast cancer risk in postmenopausal women.
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              Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

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                Author and article information

                Contributors
                +39 010 5600666 , matteo.lambertini85@gmail.com
                Journal
                BMC Med
                BMC Med
                BMC Medicine
                BioMed Central (London )
                1741-7015
                4 January 2016
                4 January 2016
                2016
                : 14
                : 1
                Affiliations
                [ ]Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino – IST, Genoa, Italy
                [ ]Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino – IST, Genoa, Italy
                [ ]Physiopathology of Human Reproduction, IRCCS AOU San Martino – IST, Genoa, Italy
                [ ]Laboratory of Reproductive Biology, Section 5712, Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, Copenhagen, Denmark
                [ ]BrEAST Data Centre, Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
                [ ]Fertility and Procreation Unit, Gynecologic Oncology Department, European Institute of Oncology, Milan, Italy
                [ ]Reproductive Medicine Department, International Evangelic Hospital, Genoa, Italy
                [ ]Physiopathology of Reproduction and In Vitro Fertilization Unit, S. Anna Hospital, University of Turin, Turin, Italy
                [ ]Department of Medical Oncology, E.O. Galliera, Genoa, Italy
                [ ]GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
                [ ]Obstetric and Gynecology Department, Azienda Ospedaliera Arcispedale S. Maria Nuova-IRCCS, University of Modena and Reggio Emilia, Reggio Emilia, Italy
                [ ]Children and Women Health Department, Physiopathology of Human Reproduction Unit, “San Giuseppe Moscati” Hospital, Avellino, Italy
                [ ]Department of Haematology/Oncology, Royal Hospital for Sick Children, and Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
                [ ]Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA USA
                Author information
                http://orcid.org/0000-0003-1797-5296
                Article
                545
                10.1186/s12916-015-0545-7
                4700580
                26728489
                3fc75d3e-2ecc-4da1-9185-cbb3472ca9b9
                © Lambertini et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 15 September 2015
                : 16 December 2015
                Funding
                Funded by: FundRef , Associazione Italiana per la Ricerca sul Cancro (AIRC);
                Award ID: 2013-14272
                Funded by: FundRef , Italian Ministry of Health;
                Award ID: CCM project, approved by D.M. 05/03/2012
                Categories
                Correspondence
                Custom metadata
                © The Author(s) 2016

                Medicine
                fertility preservation,cancer patients,survivorship issues,sperm cryopreservation,embryo cryopreservation,oocyte cryopreservation,ovarian tissue cryopreservation,luteinizing hormone-releasing hormone analogs

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