Desire for pregnancy and fertility preservation in young patients with breast cancer

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This study aimed to determine the status of patients with breast cancer under 43 years of age who desired pregnancy and FP implementation before systemic therapy. Methods This retrospective study surveyed the institutional clinical databases and electronic medical records of patients < 43 years with stage 0-III primary breast cancer at the time of surgery and treated between April 2020 and March 2021. All patients were enquired about their desire for pregnancy in a questionnaire by ‘present,’ ‘absent,’ and ‘unsure’ at their first visit. The correlation between the desire for pregnancy, FP, and clinicopathological factors was investigated. Results Among 1,005 patients who underwent surgery for primary breast cancer, 146 were included in the analysis. Thirty-four patients (23.3%) had a desire for pregnancy, and 45 patients (30.8%) chose ‘unsure’. Factors associated with the desire for pregnancy were younger age at the time of surgery (p < 0.0022), unmarried status (p < 0.001), nulliparity (p < 0.001), early-stage disease (p = 0.0016), and estrogen receptor positivity (p = 0.008). Among 115 patients who underwent systemic therapy, 13 patients (11.3%) implemented FP prior to systemic therapy. Patients who were nulliparous implemented FP more often (p = 0.0195). The FP rate was lower in patients who received neoadjuvant chemotherapy (p = 0.0863). Conclusions Our study suggests that unmarried, nulliparous, and younger patients were more interested in pregnancy, and nulliparous patients more often implemented FP. breast cancer desire for pregnancy fertility preservation young patients Figures Figure 1 Figure 2 Introduction Owing to the prolonged breast cancer treatment duration and the trend towards late marriage and childbearing [ 1 ], young patients with breast cancer may miss the opportunity to become pregnant [ 2 ]. The trends of late marriage and childbearing are more pronounced in East Asia than in North America or Europe [ 3 ]. Over the past two decades, there has been increased awareness of fertility concerns among young cancer survivors, with an emphasis on the importance of discussing cancer treatment-related infertility risks and fertility preservation options before treatment initiation [ 4 ]. In young patients with breast cancer who wish to become pregnant at the time of diagnosis, it is necessary to plan cancer treatment with a discussion on fertility preservation (FP) [ 5 ]. Patients may have more time to consider FP before systemic treatment if surgery, rather than neoadjuvant chemotherapy, is performed first. In recent years, neoadjuvant chemotherapy has been frequently administered for the treatment of early-stage breast cancer owing to the clinical importance of the response-guided approach [ 6 ]. Although a response-guided approach is important for improving prognosis, the relatively short time from the diagnosis of breast cancer to the initiation of systemic treatment limits the time available for decision-making regarding FP. Therefore, it is necessary to confirm the desire for pregnancy before initiating systemic breast cancer treatment. In our hospital, an FP working group was launched to connect patients with breast cancer with specialized reproductive facilities and to support their decision-making. However, its high cost remains a barrier. Some studies have shown that financial assistance increases access to FP among cancer patients [ 7 , 8 ]. In Japan, a project to promote FP research in patients with cancer aged < 43 years was launched in April 2021, and the number of FP procedures is expected to increase. There are few data in Japan on the percentage of patients with breast cancer under 43 years of age who wish to become pregnant and on the actual practice of FP. The POSITIVE study investigated the impact of interruption of adjuvant endocrine therapy to allow pregnancy in patients ≤ 42 years with early breast cancer, in which more Asian women had desire for pregnancy in the 40–42 years group compered to patients in Europe and North America [ 9 ]. However, most reports on the desire for pregnancy or FP in patients with breast cancer have included patients under 40 years of age. Data regarding fertility interests are needed to counsel patients about their desire for pregnancy before breast cancer treatment. This study aimed to determine the current status and factors associated with the desire for pregnancy and FP implementation before systemic therapy among patients with breast cancer under 43 years of age at the time of surgery in our institute. Methods Design and subjects This was a retrospective chart review study that surveyed institutional clinical databases and electronic medical record from April 1, 2020 to March 31, 2021. The ethics review committee of our institute approved the study protocol (No.2018–GA-1222). As this was a retrospective study, the requirement for informed consent was waived. Of the 1,005 patients who underwent surgery for primary breast cancer, we included women under 43 years of age with clinical stages 0 – III breast cancer. We excluded patients who had a previous history of malignant disease, hysterectomy, or bilateral oophorectomy, and were undergoing artificial reproductive treatment at the time of breast cancer diagnosis. Two patients had synchronous bilateral breast cancer, which is regarded as a higher-stage disease. The correlation between the desire for pregnancy, FP, and clinicopathological factors such as clinical stages, subtype, systemic treatments was investigated. We asked participants about their desire for pregnancy during their initial visit. All patients answered their desire for pregnancy in a questionnaire with three options: ‘present,’ ‘absent,’ or ‘unsure’ at the time of the first visit. Estrogen receptor positive (ER+) was defined as ≥ 10% positive nuclear staining of cancer cells. Human epidermal growth factor receptor 2 positive (HER2+) status was assessed by immunohistochemistry (positive if 3+) or dual-color in situ hybridization according to the ASCO/CAP guidelines [ 10 ] Statistical Analysis The chi-square test was used to compare categorical variables. All reported p-values were two-sided, and statistical significance was set at p-value < 0.05. All statistical analyses were performed using EZR Version 1.40 [ 11 ], a graphical user interface for R (R Foundation for Statistical Computing, Vienna, Austria). Results Among 1005 patients who underwent surgery for primary breast cancer, 146 were included in the analysis (Fig. 1 ). Patient characteristics are summarized in Table 1 . The median age at surgery was 40 years (range, 25–42 years). At the first visit, 34 patients (23.3%) had desire for pregnancy, and 45 patients (30.8%) chose ‘unsure’ (Table 2 ). Younger patients were more likely to desire pregnancy. Other factors associated with the desire for pregnancy were unmarried status (p < 0.001), nulliparity (p < 0.001), early stage disease (p = 0.0016), and estrogen receptor positivity (p = 0.008). If patients desired pregnancy, they were referred to an assisted reproduction facility as soon as possible for consultation regarding FP. Among 115 patients who underwent systemic therapy, 15 (13.0%) patients were referred to assisted reproductive clinics and 13 (11.3%) underwent FP prior to systemic therapy (Fig. 2 ). Six patients underwent embryo cryopreservation, six underwent oocyte cryopreservation, and one patient underwent both oocyte and ovarian tissue cryopreservation. Eight patients received a GnRH analog during chemotherapy to protect ovarian function. Patients who were nulliparous implemented FP more often (p = 0.0195, Table 3 ). The chi-square test showed no significant difference in breast cancer subtypes between patients with and without FP. Despite no statistically significant difference, the FP rate tended to be lower in patients who received neoadjuvant chemotherapy (p = 0.086). In this study, none of the patients with Stage III disease underwent FP. One patient refused standard systemic treatment because of a desire for a future pregnancy. Two patients abandoned the FP because of its high cost. Discussion To the best of our knowledge, this is the first study to investigate the rate of the desire for pregnancy among Japanese patients with breast cancer. A previous cohort study in the United States reported that 36% of patients under 40 years with breast cancer desired pregnancy at diagnosis, and the desire for future fertility subsequently decreased in 5 years after diagnosis [ 4 ]. Our study found that 23.3% of patients under 43 years of age at the time of surgery had desire for pregnancy at their first visit and 30.8% were ‘unsure’. The results suggest that more than half of patients under 43 years of age with breast cancer had a desire for pregnancy or were unsure about having children in the future. The ASCO clinical practice guidelines recommend that healthcare providers initiate discussions on fertility with cancer patients during their reproductive years as early as possible [ 12 ]. Discussion of fertility before systemic treatment would improve the quality of life of women of reproductive age [ 13 ]. One of the most important issues when considering FP in patients with breast cancer is that it should not delay or interrupt breast cancer treatment [ 14 ]. Close collaboration and prompt referrals to reproductive specialists are essential. In our study, patients with triple-negative or HER2-positive breast cancer were more likely to receive neoadjuvant chemotherapy, which limited the time available for FP decisions. Recently, an immune checkpoint inhibitor in neoadjuvant treatment and abemaciclib in adjuvant treatment have been introduced. Although the use of immune checkpoint inhibitors and abemaciclib as systemic treatment for patients with breast cancer at high risk of recurrence improves prognosis [ 15 – 18 ], their effects on fertility in young patients with breast cancer remain unknown. Therefore, it is important to know the future pregnancy wishes of young patients with breast cancer at the time of breast cancer diagnosis to provide information about FP and to support shared decision-making before systemic treatment. A study reported that 29% of patients with breast cancer who received fertility counseling chose FP in the Netherland [ 5 ]. In Japan, Kitano et al. reported that 43% of 212 patients with breast cancer with counseling between 2007 and 2015 underwent FP [ 19 ]. The FP rate in our study was higher than that of the previous study. This may be because physicians’ awareness of FP increased and early discussions on FP became more common. Another study in Australia reported that increased decisional conflict about pursuing FP was associated with decreased fertility-related knowledge [ 20 ]. Healthcare providers should offer easy-to-understand information on FP and consultation services for patients with breast cancer. In this study, unmarried, nulliparous, and younger patients were more interested in pregnancy. These results suggest that patients who have not completed family planning have a greater desire for pregnancy. Young patients with breast cancer are more likely to require support for reproductive life events than older adults [ 21 ]. Treatment-related infertility and the resulting unmet desire to have children may cause significant distress and have profound effects on psychosocial well-being. A European study found that women who were married or had partners had fewer psychosocial problems than single women [ 22 ]. These results suggest that unmarried and nulliparous patients need psychosocial support in addition to FP support. This study had several limitations. First, our hospital is located in an urban area with well-established medical resources, and the FP rate may be relatively high in Japan. Second, this study did not reveal any changes in the desire for pregnancy during treatment. Third, because this was a retrospective study conducted in a single hospital, the low number of patients may have led to low statistical power. Fourth, this study found that 44% of patients who chose ‘unsure’ had discussion about fertility before starting systemic treatment. However, cautious interpretation is needed because not all information on the desire for pregnancy is documented in the medical records. Fifth, approximately 95% of patients in our hospital were diagnosed or suspected with malignant disease before visiting our hospital. Thus, some patients may have abandoned their desire for pregnancy before visiting our institution. Conclusion To the best of our knowledge, this is the first study in Japan on the current status and factors associated with the desire for pregnancy in patients aged < 43 years with breast cancer. Our study suggests that unmarried, nulliparous, and younger patients had more interest in pregnancy, and nulliparous patients more often implemented FP, in accordance with previous reports from Western countries. Due to the increasing use of neoadjuvant chemotherapy in the treatment of early-stage breast cancer, it is important to develop a system to confirm the desire for future pregnancies in patients of any age. Table 1 Patients Characteristics Characteristics No. of patients (N = 146) Age at surgery, years < 35 26 (17.8%) 35–39 45 (30.8%) 40–42 75 (51.4%) Have partner No 44 (30.1%) Yes 102 (69.9%) Marriage status Not married or divorced 60 (41.1%) Married 86 (58.9%) Have child/children No 72 (49.3%) Yes 74 (50.7%) Desire for future pregnancy* Absent 67 (45.9%) Present 34 (23.3%) Unsure 45 (30.8%) BMI (kg/m 2 ) < 18.5 16 (11.0%) 18.5- 25 27 (18.5%) Germline BRCA1/BRCA2 mutation Not tested 76 (52.1%) Tested 70 (47.9%) PV**- 61 (87.1%) PV+ 9 (12.9%) cStage 0 32 (21.9%) I 44 (30.1%) II 51 (34.9%) III 19 (13.1%) Subtype ER + HER2- 102 (69.8%) ER + HER2+ 21 (14.4%) ER- HER2+ 7 (4.8%) ER- HER2- 16 (11.0%) Chemotherapy No 61 (41.8%) Yes 85 (58.2%) Neoadjuvant therapy No 111 (76.0%) Yes 35 (24.0%) Endocrine therapy No 51 (34.9%) Yes 95 (65.1%) * Desire for pregnancy: We confirmed all patients’ desire for pregnancy after cancer treatment in the initial visit questionnaire. **PV: pathologic variant Table 2 Correlation between desire for future pregnancy and clinicopathological factors Present N = 34 (%) Unsure N = 45 (%) Absent N = 67 (%) P value Age at surgery, years 0.0023 < 35 13 (38.2) 7 (15.6) 6 (9.0) 35–39 12 (35.3) 14(31.1) 19 (28.4) 40–42 9 (26.5) 24(53.3) 42 (62.7) Have partner No 14 (41.2) 19 (42.2) 11 (16.4) 0.0032 Yes 20 (58.8) 26 (58.8) 56 (83.6) Marriage status Not married or divorced 21 (61.8) 23 (51.1) 16 (23.9) 0.0002 married 13 (38.2) 22 (48.9) 51 (76.1) Have child/children No 30 (88.2) 23 (51.1) 19 (28.4) < 0.0001 Yes 4 (11.8) 22 (48.9) 48 (71.6) BMI (kg/m 2 ) < 18.5 3 (8.8) 4 (8.9) 9 (13.4) 0.863 18.5- 25 5 (14.7) 10 (22.2) 12 (17.9) BRCA testing Not tested 12 (35.3) 27 (60.0) 37 (55.2) 0.0788 Tested 22 (64.7) 18 (40.0) 30 (44.8) cStage 0 16 (47.1) 10 (22.2) 6 (9.0) 0.0016 I 8 (23.5) 13 (28.9) 23 (34.3) II 9 (26.5) 14 (31.1) 28 (41.8) III 1 (2.9) 8 (17.8) 10 (14.9) Subtype ER + HER2- 30 (88.2) 33 (73.3) 39 (58.2) 0.0068 ER + HER2+ 2 (5.9) 3 (6.7) 16 (23.9) ER- HER2+ 0 (0.0) 5 (11.1) 2 (3.0) ER- HER2- 2 (5.9) 4 (8.9) 10 (14.9) Table 3 Correlation between implementation of FP and clinicopathological factors in patients receiving systemic treatment with desire for pregnancy and unsure (N = 55) With FP N = 13 (%) Without FP N = 42 (%) P value Age at operation, years < 35 5 (38.5) 10 (23.8) 0.11 35–39 6 (46.2) 12 (28.6) 40–42 2 (15.4) 20 (47.6) Have partner No 3 (23.1) 18 (42.9) 0.328 Yes 10 (76.9) 24 (57.1) Have child/children No 12 (92.3) 23 (54.8) 0.0195 Yes 1 (7.7) 19 (45.2) BMI (kg/m 2 ) < 18.5 0 (0.0) 4 (9.5) 0.393 18.5- 25 2 (15.4) 12 (28.6) Genetic test Not tested 4 (30.8) 22 (52.4) 0.215 Tested 9 (69.2) 20 (47.6) cStage 0 1 (7.7) 2 (4.8) 0.25 I 5 (38.5) 15 (35.7) II 7 (53.8) 16 (38.1) III 0 (0.0) 9 (21.4) Subtype ER + HER2- 10 (76.9) 34 (81.0) 0.322 ER + HER2+ 2 (15.4) 1 (2.4) ER- HER2+ 0 (0.0) 3 (7.1) ER- HER2- 1 (7.7) 4 (9.5) Chemotherapy Not done 3 (23.1) 15 (35.7) 0.51 Done 10 (76.9) 27 (64.3) Neoadjuvant therapy No 12 (92.3) 28 (66.7) 0.0863 Yes 1 (7.7) 14 (33.3) Endocrine therapy No 2 (15.4) 6 (15.4) 1 Yes 11 (84.6) 36 (84.6) Abbreviations FP, fertility preservation Declarations Acknowledgments The authors thank the patients included in this study. The authors also thank the CIH staff and Ms Rie Gokan for their great efforts in medical practice and in the database registration. Competing Interests The authors have no relevant financial or nonfinancial interests to disclose. Author Contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Tomomi Abe. The first draft of the manuscript was written by Tomomi Abe, Akemi Kataoka, Takayuki Ueno, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Data availability statement The datasets generated during and/ or analysed during the current study are available from the corresponding authors on reasonable requests. Ethics approval This study protocol (approval no. 2018-1100) was approved by the CIH's independent ethical committee/institutional review board and was carried out in accordance with the Helsinki Declaration. 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Breast 2019;47:85-92. https://doi.org/10.1016/j.breast.2019.07.001 Cite Share Download PDF Status: Published Journal Publication published 25 Sep, 2024 Read the published version in Breast Cancer → Version 1 posted Editorial decision: Major Revision 19 May, 2024 Reviewers agreed at journal 27 Mar, 2024 Reviewers invited by journal 25 Mar, 2024 Editor assigned by journal 22 Mar, 2024 First submitted to journal 21 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4142861","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":283816836,"identity":"d08dc48e-a7dd-4c9d-8fdd-9b3a66c65e24","order_by":0,"name":"Tomomi 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10:45:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4142861/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4142861/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s12282-024-01633-y","type":"published","date":"2024-09-25T15:57:32+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":53753955,"identity":"731f3513-f9af-4505-a75d-202b500afa9a","added_by":"auto","created_at":"2024-03-29 18:55:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25865,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart for the patient selection\u003c/p\u003e","description":"","filename":"Slide1.png","url":"https://assets-eu.researchsquare.com/files/rs-4142861/v1/5a3006740d5d1d73761b8cec.png"},{"id":53753952,"identity":"404b119c-be82-4dc9-bb12-3cc017b81b9e","added_by":"auto","created_at":"2024-03-29 18:55:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":18912,"visible":true,"origin":"","legend":"\u003cp\u003eFertility preservation prior to breast cancer systemic treatment\u003c/p\u003e\n\u003cp\u003eFP: Fertility preservation (embryo cryopreservation, oocyte cryopreservation, or ovarian tissue cryopreservation).\u003c/p\u003e","description":"","filename":"Slide2.png","url":"https://assets-eu.researchsquare.com/files/rs-4142861/v1/6a0850f3d0c4381ff027c47f.png"},{"id":65627226,"identity":"d4c3c561-5b7c-4d25-8b06-e277cec8d8f9","added_by":"auto","created_at":"2024-09-30 16:13:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":583779,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4142861/v1/b7743ba0-45a7-4def-87fb-adf2b3234e7c.pdf"}],"financialInterests":"","formattedTitle":"Desire for pregnancy and fertility preservation in young patients with breast cancer","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOwing to the prolonged breast cancer treatment duration and the trend towards late marriage and childbearing [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], young patients with breast cancer may miss the opportunity to become pregnant [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The trends of late marriage and childbearing are more pronounced in East Asia than in North America or Europe [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Over the past two decades, there has been increased awareness of fertility concerns among young cancer survivors, with an emphasis on the importance of discussing cancer treatment-related infertility risks and fertility preservation options before treatment initiation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In young patients with breast cancer who wish to become pregnant at the time of diagnosis, it is necessary to plan cancer treatment with a discussion on fertility preservation (FP) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients may have more time to consider FP before systemic treatment if surgery, rather than neoadjuvant chemotherapy, is performed first. In recent years, neoadjuvant chemotherapy has been frequently administered for the treatment of early-stage breast cancer owing to the clinical importance of the response-guided approach [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Although a response-guided approach is important for improving prognosis, the relatively short time from the diagnosis of breast cancer to the initiation of systemic treatment limits the time available for decision-making regarding FP. Therefore, it is necessary to confirm the desire for pregnancy before initiating systemic breast cancer treatment.\u003c/p\u003e \u003cp\u003eIn our hospital, an FP working group was launched to connect patients with breast cancer with specialized reproductive facilities and to support their decision-making. However, its high cost remains a barrier. Some studies have shown that financial assistance increases access to FP among cancer patients [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In Japan, a project to promote FP research in patients with cancer aged \u0026lt; 43 years was launched in April 2021, and the number of FP procedures is expected to increase. There are few data in Japan on the percentage of patients with breast cancer under 43 years of age who wish to become pregnant and on the actual practice of FP. The POSITIVE study investigated the impact of interruption of adjuvant endocrine therapy to allow pregnancy in patients ≤ 42 years with early breast cancer, in which more Asian women had desire for pregnancy in the 40–42 years group compered to patients in Europe and North America [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, most reports on the desire for pregnancy or FP in patients with breast cancer have included patients under 40 years of age. Data regarding fertility interests are needed to counsel patients about their desire for pregnancy before breast cancer treatment.\u003c/p\u003e \u003cp\u003eThis study aimed to determine the current status and factors associated with the desire for pregnancy and FP implementation before systemic therapy among patients with breast cancer under 43 years of age at the time of surgery in our institute.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eDesign and subjects\u003c/p\u003e\u003cp\u003e This was a retrospective chart review study that surveyed institutional clinical databases and electronic medical record from April 1, 2020 to March 31, 2021. The ethics review committee of our institute approved the study protocol (No.2018–GA-1222). As this was a retrospective study, the requirement for informed consent was waived.\u003c/p\u003e\u003cp\u003eOf the 1,005 patients who underwent surgery for primary breast cancer, we included women under 43 years of age with clinical stages 0 – III breast cancer. We excluded patients who had a previous history of malignant disease, hysterectomy, or bilateral oophorectomy, and were undergoing artificial reproductive treatment at the time of breast cancer diagnosis. Two patients had synchronous bilateral breast cancer, which is regarded as a higher-stage disease. The correlation between the desire for pregnancy, FP, and clinicopathological factors such as clinical stages, subtype, systemic treatments was investigated. We asked participants about their desire for pregnancy during their initial visit. All patients answered their desire for pregnancy in a questionnaire with three options: ‘present,’ ‘absent,’ or ‘unsure’ at the time of the first visit. Estrogen receptor positive (ER+) was defined as ≥ 10% positive nuclear staining of cancer cells. Human epidermal growth factor receptor 2 positive (HER2+) status was assessed by immunohistochemistry (positive if 3+) or dual-color in situ hybridization according to the ASCO/CAP guidelines [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eThe chi-square test was used to compare categorical variables. All reported p-values were two-sided, and statistical significance was set at p-value \u0026lt; 0.05. All statistical analyses were performed using EZR Version 1.40 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], a graphical user interface for R (R Foundation for Statistical Computing, Vienna, Austria).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong 1005 patients who underwent surgery for primary breast cancer, 146 were included in the analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Patient characteristics are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The median age at surgery was 40 years (range, 25\u0026ndash;42 years). At the first visit, 34 patients (23.3%) had desire for pregnancy, and 45 patients (30.8%) chose \u0026lsquo;unsure\u0026rsquo; (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Younger patients were more likely to desire pregnancy. Other factors associated with the desire for pregnancy were unmarried status (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), nulliparity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), early stage disease (p\u0026thinsp;=\u0026thinsp;0.0016), and estrogen receptor positivity (p\u0026thinsp;=\u0026thinsp;0.008).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIf patients desired pregnancy, they were referred to an assisted reproduction facility as soon as possible for consultation regarding FP. Among 115 patients who underwent systemic therapy, 15 (13.0%) patients were referred to assisted reproductive clinics and 13 (11.3%) underwent FP prior to systemic therapy (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Six patients underwent embryo cryopreservation, six underwent oocyte cryopreservation, and one patient underwent both oocyte and ovarian tissue cryopreservation. Eight patients received a GnRH analog during chemotherapy to protect ovarian function. Patients who were nulliparous implemented FP more often (p\u0026thinsp;=\u0026thinsp;0.0195, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The chi-square test showed no significant difference in breast cancer subtypes between patients with and without FP. Despite no statistically significant difference, the FP rate tended to be lower in patients who received neoadjuvant chemotherapy (p\u0026thinsp;=\u0026thinsp;0.086). In this study, none of the patients with Stage III disease underwent FP. One patient refused standard systemic treatment because of a desire for a future pregnancy. Two patients abandoned the FP because of its high cost.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo the best of our knowledge, this is the first study to investigate the rate of the desire for pregnancy among Japanese patients with breast cancer. A previous cohort study in the United States reported that 36% of patients under 40 years with breast cancer desired pregnancy at diagnosis, and the desire for future fertility subsequently decreased in 5 years after diagnosis [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Our study found that 23.3% of patients under 43 years of age at the time of surgery had desire for pregnancy at their first visit and 30.8% were \u0026lsquo;unsure\u0026rsquo;. The results suggest that more than half of patients under 43 years of age with breast cancer had a desire for pregnancy or were unsure about having children in the future. The ASCO clinical practice guidelines recommend that healthcare providers initiate discussions on fertility with cancer patients during their reproductive years as early as possible [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Discussion of fertility before systemic treatment would improve the quality of life of women of reproductive age [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. One of the most important issues when considering FP in patients with breast cancer is that it should not delay or interrupt breast cancer treatment [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Close collaboration and prompt referrals to reproductive specialists are essential.\u003c/p\u003e \u003cp\u003eIn our study, patients with triple-negative or HER2-positive breast cancer were more likely to receive neoadjuvant chemotherapy, which limited the time available for FP decisions. Recently, an immune checkpoint inhibitor in neoadjuvant treatment and abemaciclib in adjuvant treatment have been introduced. Although the use of immune checkpoint inhibitors and abemaciclib as systemic treatment for patients with breast cancer at high risk of recurrence improves prognosis [\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], their effects on fertility in young patients with breast cancer remain unknown. Therefore, it is important to know the future pregnancy wishes of young patients with breast cancer at the time of breast cancer diagnosis to provide information about FP and to support shared decision-making before systemic treatment.\u003c/p\u003e \u003cp\u003eA study reported that 29% of patients with breast cancer who received fertility counseling chose FP in the Netherland [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In Japan, Kitano et al. reported that 43% of 212 patients with breast cancer with counseling between 2007 and 2015 underwent FP [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The FP rate in our study was higher than that of the previous study. This may be because physicians\u0026rsquo; awareness of FP increased and early discussions on FP became more common. Another study in Australia reported that increased decisional conflict about pursuing FP was associated with decreased fertility-related knowledge [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Healthcare providers should offer easy-to-understand information on FP and consultation services for patients with breast cancer.\u003c/p\u003e \u003cp\u003eIn this study, unmarried, nulliparous, and younger patients were more interested in pregnancy. These results suggest that patients who have not completed family planning have a greater desire for pregnancy. Young patients with breast cancer are more likely to require support for reproductive life events than older adults [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Treatment-related infertility and the resulting unmet desire to have children may cause significant distress and have profound effects on psychosocial well-being. A European study found that women who were married or had partners had fewer psychosocial problems than single women [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These results suggest that unmarried and nulliparous patients need psychosocial support in addition to FP support.\u003c/p\u003e \u003cp\u003eThis study had several limitations. First, our hospital is located in an urban area with well-established medical resources, and the FP rate may be relatively high in Japan. Second, this study did not reveal any changes in the desire for pregnancy during treatment. Third, because this was a retrospective study conducted in a single hospital, the low number of patients may have led to low statistical power. Fourth, this study found that 44% of patients who chose \u0026lsquo;unsure\u0026rsquo; had discussion about fertility before starting systemic treatment. However, cautious interpretation is needed because not all information on the desire for pregnancy is documented in the medical records. Fifth, approximately 95% of patients in our hospital were diagnosed or suspected with malignant disease before visiting our hospital. Thus, some patients may have abandoned their desire for pregnancy before visiting our institution.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTo the best of our knowledge, this is the first study in Japan on the current status and factors associated with the desire for pregnancy in patients aged\u0026thinsp;\u0026lt;\u0026thinsp;43 years with breast cancer. Our study suggests that unmarried, nulliparous, and younger patients had more interest in pregnancy, and nulliparous patients more often implemented FP, in accordance with previous reports from Western countries.\u003c/p\u003e \u003cp\u003eDue to the increasing use of neoadjuvant chemotherapy in the treatment of early-stage breast cancer, it is important to develop a system to confirm the desire for future pregnancies in patients of any age.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatients Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. of patients (N\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge at surgery, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (17.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (30.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e40\u0026ndash;42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (51.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44 (30.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e102 (69.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarriage status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot married or divorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60 (41.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86 (58.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave child/children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72 (49.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74 (50.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDesire for future pregnancy*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67 (45.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (23.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnsure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (30.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (11.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.5-\u0026lt;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e103 (70.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (18.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGermline \u003cem\u003eBRCA1/BRCA2\u003c/em\u003e mutation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot tested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76 (52.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70 (47.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePV**-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61 (87.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePV+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (12.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecStage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (21.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44 (30.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (34.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (13.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubtype\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eER\u0026thinsp;+\u0026thinsp;HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e102 (69.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eER\u0026thinsp;+\u0026thinsp;HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (14.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eER- HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eER- HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (11.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61 (41.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85 (58.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoadjuvant therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e111 (76.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (24.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndocrine therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (34.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95 (65.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e* Desire for pregnancy: We confirmed all patients\u0026rsquo; desire for pregnancy after cancer treatment in the initial visit questionnaire.\u003c/p\u003e \u003cp\u003e**PV: pathologic variant\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between desire for future pregnancy and clinicopathological factors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;34 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUnsure\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;45 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;67 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge at surgery, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6 (9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14(31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19 (28.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e40\u0026ndash;42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24(53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e42 (62.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19 (42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11 (16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (58.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26 (58.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e56 (83.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarriage status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot married or divorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (61.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16 (23.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22 (48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e51 (76.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave child/children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30 (88.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19 (28.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22 (48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e48 (71.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9 (13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.863\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.5-\u0026lt;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (76.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31 (68.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e46 (68.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBRCA testing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot tested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e37 (55.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0788\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (64.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30 (44.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecStage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6 (9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (23.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23 (34.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14 (31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28 (41.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8 (17.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubtype\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eER\u0026thinsp;+\u0026thinsp;HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30 (88.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33 (73.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e39 (58.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0068\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eER\u0026thinsp;+\u0026thinsp;HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16 (23.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eER- HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2 (3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eER- HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between implementation of FP and clinicopathological factors in patients receiving systemic treatment with desire for pregnancy and unsure (N\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith FP\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;13 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWithout FP\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;42 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge at operation, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10 (23.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e40\u0026ndash;42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20 (47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.328\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (76.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave child/children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (92.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23 (54.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0195\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19 (45.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.393\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.5-\u0026lt;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (84.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26 (61.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGenetic test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot tested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22 (52.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20 (47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecStage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15 (35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16 (38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9 (21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubtype\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eER\u0026thinsp;+\u0026thinsp;HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (76.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34 (81.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.322\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eER\u0026thinsp;+\u0026thinsp;HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eER- HER2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eER- HER2-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot done\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15 (35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (76.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27 (64.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoadjuvant therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (92.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0863\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndocrine therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (84.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36 (84.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eFP, fertility preservation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eThe authors thank the patients included in this study. The authors also thank the CIH staff and Ms Rie Gokan for their great efforts in medical practice and in the database registration.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Competing Interests\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or nonfinancial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Author Contributions\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Tomomi Abe. The first draft of the manuscript was written by Tomomi Abe, Akemi Kataoka, Takayuki Ueno, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Data availability statement\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/ or analysed during the current study are available from the corresponding authors on reasonable requests.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Ethics approval\u003c/p\u003e\n\u003cp\u003eThis study protocol (approval no. 2018-1100) was approved by the CIH\u0026apos;s independent ethical committee/institutional review board and was carried out in accordance with the Helsinki Declaration.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Consent to participate\u003c/p\u003e\n\u003cp\u003eInformed consent was exempted because of the retrospective format of this study.\u003c/p\u003e"},{"header":"References","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003col\u003e\n\u003cli\u003eMills M, Rindfuss RR, McDonald P, te Velde E, ESHRE Reproduction and Society Task Force. Why do people postpone parenthood? Reasons and social policy incentives. Hum Reprod Update 2011;17:848-860. https://doi.org/10.1093/humupd/dmr026\u003c/li\u003e\n\u003cli\u003eAngarita AM, Johnson CA, Fader AN, Christianson MS. Fertility Preservation: A Key Survivorship Issue for Young Women with Cancer. Front Oncol 2016;6:102. https://doi.org/10.3389/fonc.2016.00102\u003c/li\u003e\n\u003cli\u003eRaymo JM, Park H, Xie Y, Yeung WJ. Marriage and Family in East Asia: Continuity and Change. Annu Rev Sociol 2015;41:471-492. https://doi.org/10.1146/annurev-soc-073014-112428\u003c/li\u003e\n\u003cli\u003ePoorvu PD, Gelber SI, Zheng Y, Ruddy KJ, Tamimi RM, Peppercorn J et al. Pregnancy after breast cancer: Results from a prospective cohort of young women with breast cancer. Cancer 2021;127:1021-1028. https://doi.org/10.1002/cncr.33342\u003c/li\u003e\n\u003cli\u003eVriens IJH, Ter Welle-Butalid EM, de Boer M, de Die-Smulders CEM, Derhaag JG, Geurts SME et al. Preserving fertility in young women undergoing chemotherapy for early breast cancer; the Maastricht experience. Breast Cancer Res Treat 2020;181:77-86. https://doi.org/10.1007/s10549-020-05598-2\u003c/li\u003e\n\u003cli\u003eVon Minckwitz G, Blohmer JU, Costa SD, Denkert C, Eidtmann H, Eiermann W, et al. Response-Guided Neoadjuvant Chemotherapy for Breast Cancer. J Clin Oncol 2013;31:3623-3630. https:/doi.org/10.1200/JCO.2012.45.0940\u003c/li\u003e\n\u003cli\u003eOmesi L, Narayan A, Reinecke J, Schear R, Levine J. Financial Assistance for Fertility Preservation Among Adolescent and Young Adult Cancer Patients: A Utilization Review of the Sharing Hope/LIVESTRONG Fertility Financial Assistance Program. J Adolesc Young Adult Oncol 2019;8:554-559. https://doi.org/10.1089/jayao.2018.0151\u003c/li\u003e\n\u003cli\u003ePeipert BJ, Hairston JC, McQueen DB, Hammond C, Feinberg EC. Increasing access to fertility care through private foundations. Fertil Steril 2019;111:1211-1216. https://doi.org/10.1016/j.fertnstert.2019.02.025\u003c/li\u003e\n\u003cli\u003ePartridge AH, Niman SM, Ruggeri M, Peccatori FA, Azim HA, Colleoni M, et al. Who are the women who enrolled in the POSITIVE trial: A global study to support young hormone receptor positive breast cancer survivors desiring pregnancy. Breast 2021;59:327-338. https://doi.org/ 10.1016/j.breast.2021.07.021\u003c/li\u003e\n\u003cli\u003eWolff AC, Hammond MEH, Allison KH, Harvey BE, Mangu PB, Bartlett JMS et al. Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update. J Clin Oncol 2018;36:2105-2122. https://doi.org/10.1200/JCO.2018.77.8738\u003c/li\u003e\n\u003cli\u003eKanda Y.Investigation of the freely available easy-to-use software \u0026lsquo;EZR\u0026rsquo; for medical statistics. Bone Marrow Transplant 2013;48:452-458. https://doi.org/10.1038/bmt.2012.244\u003c/li\u003e\n\u003cli\u003eOktay K, Harvey BE, Partridge AH, Quinn GP, Reinecke J, Taylor HS, et al. Fertility Preservation in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol 2018;36: 1994-2001. https://doi.org/10.1200/JCO.2018.78.1914\u003c/li\u003e\n\u003cli\u003eLetourneau JM, Ebbel EE, Katz PP, Katz A, Ai WZ, Chien AJ et al. Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer. Cancer 2012;118:1710-1717. https://doi.org/10.1002/cncr.26459\u003c/li\u003e\n\u003cli\u003eHarada M, Osuga Y. Fertility preservation for female cancer patients. Int J Clin Oncol 2019;24:28-33. https://doi.org/10.1007/s10147-018-1252-0\u003c/li\u003e\n\u003cli\u003eMasuda N, Lee SJ, Ohtani S, Im YH, Lee ES, Yokota I, et al. Adjuvant Capecitabine for Breast Cancer after Preoperative Chemotherapy. N Engl J Med 2017;376:2147-2159. https://doi.org/10.1056/NEJMoa1612645\u003c/li\u003e\n\u003cli\u003eVon Minckwitz G, Huang CS, Mano MS, Loibl S, Mamounas EP, Untch M, et al. Trastuzumab Emtansine for Residual Invasive HER2-Positive Breast Cancer. N Engl J Med 2019;380:617-628. https://doi.org/10.1056/NEJMoa1814017\u003c/li\u003e\n\u003cli\u003eJohnston SRD, Harbeck N, Hegg R, Toi M, Martin M, Shao ZM, et al. Abemaciclib Combined With Endocrine Therapy for the Adjuvant Treatment of HR+, HER2\u0026minus;, Node-Positive, High-Risk, Early Breast Cancer (monarchE). J Clin Oncol 2020;38:3987-3998. https://doi.org/10.1200/JCO.20.02514\u003c/li\u003e\n\u003cli\u003eSchmid P, Cortes J, Pusztai L, McArthur H, K\u0026uuml;mmel S, Bergh J, et al. Pembrolizumab for Early Triple-Negative Breast Cancer. N Engl J Med 2020;382:810-821. https://doi.org/10.1056/NEJMoa1910549\u003c/li\u003e\n\u003cli\u003eKitano A, Shimizu C, Yamauchi H, Akitani F, Shiota K, Miyoshi Y, et al. Factors associated with treatment delay in women with primary breast cancer who were referred to reproductive specialists. ESMO Open 2019;4:e000459. https://doi.org/10.1136/esmoopen-2018-000459\u003c/li\u003e\n\u003cli\u003ePeate M, Meiser B, Friedlander M, Zorbas H, Rovelli S, Sansom-Daly U, et al. It\u0026apos;s Now or Never: Fertility-Related Knowledge, Decision-Making Preferences, and Treatment Intentions in Young Women With Breast Cancer\u0026mdash;An Australian Fertility Decision Aid Collaborative Group Study.J Clin Oncol 2011;29:1670-1677. https://doi.org/10.1200/JCO.2010.31.2462\u003c/li\u003e\n\u003cli\u003eZebrack B. Information and service needs for young adult cancer patients. Support Care Cancer 2008;16:1353-1360. https://doi.org/10.1007/s00520-008-0435-z\u003c/li\u003e\n\u003cli\u003eRuggeri M, Pagan E, Bagnardi V, Bianco N, Gallerani E, Buser K, et al. Fertility concerns, preservation strategies and quality of life in young women with breast cancer: Baseline results from an ongoing prospective cohort study in selected European Centers. Breast 2019;47:85-92. https://doi.org/10.1016/j.breast.2019.07.001\u003c/li\u003e\n \u003c/ol\u003e\n\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"breast-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"brca","sideBox":"Learn more about [Breast Cancer](http://link.springer.com/journal/12282)","snPcode":"12282","submissionUrl":"https://www.editorialmanager.com/brca/default2.aspx","title":"Breast Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"breast cancer, desire for pregnancy, fertility preservation, young patients","lastPublishedDoi":"10.21203/rs.3.rs-4142861/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4142861/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eData on the desire for pregnancy and the status of fertility preservation (FP) in patients with breast cancer remains unclear. This study aimed to determine the status of patients with breast cancer under 43 years of age who desired pregnancy and FP implementation before systemic therapy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective study surveyed the institutional clinical databases and electronic medical records of patients\u0026thinsp;\u0026lt;\u0026thinsp;43 years with stage 0-III primary breast cancer at the time of surgery and treated between April 2020 and March 2021. All patients were enquired about their desire for pregnancy in a questionnaire by \u0026lsquo;present,\u0026rsquo; \u0026lsquo;absent,\u0026rsquo; and \u0026lsquo;unsure\u0026rsquo; at their first visit. The correlation between the desire for pregnancy, FP, and clinicopathological factors was investigated.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 1,005 patients who underwent surgery for primary breast cancer, 146 were included in the analysis. Thirty-four patients (23.3%) had a desire for pregnancy, and 45 patients (30.8%) chose \u0026lsquo;unsure\u0026rsquo;. Factors associated with the desire for pregnancy were younger age at the time of surgery (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0022), unmarried status (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), nulliparity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), early-stage disease (p\u0026thinsp;=\u0026thinsp;0.0016), and estrogen receptor positivity (p\u0026thinsp;=\u0026thinsp;0.008). Among 115 patients who underwent systemic therapy, 13 patients (11.3%) implemented FP prior to systemic therapy. Patients who were nulliparous implemented FP more often (p\u0026thinsp;=\u0026thinsp;0.0195). The FP rate was lower in patients who received neoadjuvant chemotherapy (p\u0026thinsp;=\u0026thinsp;0.0863).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOur study suggests that unmarried, nulliparous, and younger patients were more interested in pregnancy, and nulliparous patients more often implemented FP.\u003c/p\u003e","manuscriptTitle":"Desire for pregnancy and fertility preservation in young patients with breast cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-29 18:55:25","doi":"10.21203/rs.3.rs-4142861/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major Revision","date":"2024-05-19T18:23:53+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2024-03-27T07:15:20+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-25T23:40:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-22T04:48:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"Breast Cancer","date":"2024-03-21T06:45:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"breast-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"brca","sideBox":"Learn more about [Breast Cancer](http://link.springer.com/journal/12282)","snPcode":"12282","submissionUrl":"https://www.editorialmanager.com/brca/default2.aspx","title":"Breast Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"85b8ce86-583d-4d17-a767-cb4670923f93","owner":[],"postedDate":"March 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-30T16:03:35+00:00","versionOfRecord":{"articleIdentity":"rs-4142861","link":"https://doi.org/10.1007/s12282-024-01633-y","journal":{"identity":"breast-cancer","isVorOnly":false,"title":"Breast Cancer"},"publishedOn":"2024-09-25 15:57:32","publishedOnDateReadable":"September 25th, 2024"},"versionCreatedAt":"2024-03-29 18:55:25","video":"","vorDoi":"10.1007/s12282-024-01633-y","vorDoiUrl":"https://doi.org/10.1007/s12282-024-01633-y","workflowStages":[]},"version":"v1","identity":"rs-4142861","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4142861","identity":"rs-4142861","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}