Fertility Counseling in Breast Cancer: Dr. Don Dizon on Early Referral

The management of breast cancer in younger patients requires a multifaceted approach that extends beyond oncologic outcomes to encompass quality-of-life considerations, most notably reproductive health. In a recent interview with Oncology Nursing News, Don S. Dizon, MD, FACP, FASCO, the Jane F. Desforges Chair in Hematology and Oncology and professor of medicine at Tufts Medicine, emphasized the critical importance of integrating fertility counseling into the initial treatment planning phase.

The necessity of early referral

According to Dizon, the discussion regarding fertility should not be a secondary consideration or a delayed conversation. Instead, it must be established as a standard component of the diagnostic and treatment-planning period.

"It's really important that [fertility] be something that people have mentioned at the time you’re talking to them about the diagnosis," Dizon noted. He stressed that when clinicians are reviewing systemic treatment options, many of which carry gonadotoxic risks, fertility should be "one of the first things we ask."

For oncology nurses and clinicians, this highlights a shift toward proactive survivorship planning. Waiting until after the initiation of chemotherapy or endocrine therapy can significantly limit a patient’s options, such as oocyte or embryo cryopreservation. Early referral to a reproductive endocrinology and infertility (REI) specialist ensures that patients have the widest possible range of choices before their ovarian reserve is potentially compromised by treatment.

Challenging assumptions in clinical practice and evolving perspectives on parenthood

A key takeaway from Dizon’s insights is the necessity of avoiding assumptions based on a patient’s current family status or age. He cautioned against the internal bias that a patient may not be interested in future fertility simply because of their diagnosis or existing circumstances.

Dizon also remarked on the longitudinal nature of these conversations. A patient’s perspective on parenthood may shift significantly from the time of diagnosis through the years of survivorship. While a patient may initially focus solely on survival, their desire for a family may resurface or change after the acute phase of treatment has passed. This is particularly relevant for patients undergoing long-term adjuvant therapies.

Even for those who experience treatment-induced menopause or require extended ovarian suppression, the dream of parenthood remains attainable through various means. Dizon urged clinicians to remain open to these conversations throughout the continuum of care, ensuring that survivors feel supported in their evolving goals for family building.

Transcript

How do you approach counseling patients about fertility options after breast cancer diagnosis, especially on your emphasis on early referral for fertility counseling?

After a diagnosis of breast cancer, it's really important that that be something that people have mentioned at the time you're talking to them about the diagnosis, at the time you're reviewing their treatment options; it should be one of the first things we ask. And not assume that people who have been diagnosed with breast cancer are not interested in future fertility, but to get them into the hands of someone who can really go through options. As critical though, it's important to understand that people who underwent breast cancer treatments may change their minds after the therapy, and so being open to having those conversations about parenthood, especially if someone, say underwent treatment and has to go under ovarian suppression, for example, or maybe had an early menopausal treatment, they can still experience parenthood. So that's really critical.