Fertility Counseling in Survivors of Cancer in Childhood and Adolescence: Time for a Reappraisal?

SIMPLE SUMMARY: Genetic predisposition to a disease obliges women to face the fear of transmitting cancer to their offspring. This might affect their willingness to seek pregnancy and adhere to fertility preservation programs. This often-neglected issue should be discussed during fertility counseling, and patients should be offered options to overcome the problem (i.e., PGT-M, egg donation and adoption). This opinion paper arose from the authors’ multiple discussions and meetings on this subject. ABSTRACT: Genetic predisposition could have an important role in the pathogenesis of cancers in children and adolescents. A recent study by our group showed that, among female survivors of cancers in childhood and adolescence, the proportion of cases involving a possible genetic predisposition was sizable (at least one in five). Our sample is too small to be representative of the general population, but it gave us an opportunity to reappraise this issue. Women with a genetic predisposition can transmit the risk of cancer to their offspring, and their awareness of this may influence their reproductive and fertility preservation choices. In our experience, a predisposition to cancer receives little attention in the fertility counseling and decision-making process unless a patient already has a definitive molecular diagnosis of a hereditary cancer syndrome. We feel it is essential to empower women on this issue, particularly as there are ways to overcome the problem, including preimplantation genetic testing (PGT-M) in definitively diagnosed cases, egg donation and adoption. In the context of fertility counseling for survivors of cancer in childhood and adolescence who have reached adulthood, the risk of transmitting a predisposition to cancer should be discussed with patients, if relevant and desired.