To explore the factors that affect the awareness of fertility-related issues in very young breast cancer patients and analyze the prognostic factors.

This retrospective study involved 50 very young female breast cancer patients (≤25 years) with complete clinicopathological data in the Breast Disease Center, the Fourth Hospital of Hebei Medical University from December 2009 to January 2019. All patients completed the Fertility Issues and Outcomes Scale (FIS). Univariate and multivariate Logistic regression models were used to evaluate the relationship between sociodemographic factors, tumor factors and awareness of fertility-related issues. Kaplan-Meier method was used for survival analysis and log-rank test was used for comparison between groups. The Cox proportional hazards regression model was used to explore the factors that affect the prognosis of very young breast cancer patients.

Among 50 very young breast cancer patients, 36 patients had not communicated with their doctors on fertility-related issues after diagnosis or before treatment, and only 14 patients had discussed about those issues; 28 patients expressed their wills to have children after treatment; 11 patients had pregnancy after breast cancer treatment, accounting for 22% (11/50) of all patients. Among them, 6 patients had abortions without counselling their doctors and other five patients had healthy newborns after full-term pregnancy. The univariate and multivariate Logistic regression analyses showed that the fertility status before diagnosis was an independent factor affecting the awareness of fertility-related issues in very young breast cancer patients (univariate: OR=0.250, 95%CI: 0.070-0.897, P=0.033; multivariate: OR=0.270, 95%CI: 0.048-0.901, P=0.035). Nine patients (18%, 9/50) had recurrence or metastasis, including seven breast cancer-related deaths (14%, 7/50). Univariate analysis showed that diagnosis delay time was an influencing factor of DFS and OS (χ²=8.857, 6.928, P=0.003, 0.008), and pathological type was an influencing factor of DFS (χ²=4.824, P=0.028), but not an influencing factor of OS (χ²=3.339, P=0.069). The results of multivariate analysis showed that diagnosis delay time was an independent prognostic factor of DFS (HR=13.121, 95%CI: 1.385-124.348, P=0.025) in very young breast cancer patients. The survival analysis showed that the patients with delayed diagnosis > 3 months had worse DFS compared with patients with delayed diagnosis≤3 months (χ²=4.834, P=0.025), but OS presented no significant difference (χ²=1.035, P=0.311).

The breast cancer patients who have not given birth before treatment are highly concerned about fertility-related issues. The delayed diagnosis may lead to poor prognosis in very young breast cancer patients, which deserves special attention of clinicians.