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Consistent and compassionate conversations with her patient revealed a shocking and treatment-altering discovery.

Adjuvant treatment options for premenopausal women with hormone receptor–positive breast cancer now include endocrine therapy and ovarian function suppression (OFS) based on clinicopathologic characteristics that determine composite risk of recurrence.

Understanding the role of the estrogen receptor (ER) in the pathogenesis of breast cancer has led to the development of treatment options that lead to reduced estrogen levels. In addition, the expression level of ER can serve as a prognostic indicator for disease recurrence and treatment response.

With the availability of approaches for preserving fertility and ovarian function, physicians should be prepared to discuss the impact of chemotherapy on fertility and ovarian function with patients newly diagnosed with breast cancer in order to personalize treatment plans based on patients’ goals. In the modern era, an increasing number of women are opting to delay pregnancy.

Measuring estradiol levels during ovarian function suppression (OFS) remains debatable. It can be argued that the assessment of estradiol levels is clinically irrelevant since general OFS can be achieved with the currently available approaches, and the outcomes of OFS trials are not based on estradiol levels. However, a variety of factors may lead to ovarian escape (OE).

Despite the fact that 51% of patients with breast cancer have reported fertility concerns, evidence indicates that fertility preservation methods are underutilized.

Studies have demonstrated that at least half of patients undergoing treatment for breast cancer are concerned about potential infertility and demonstrate interest in becoming pregnant after the conclusion of their treatment. Even those not interested in pregnancy seek to avoid ovarian insufficiency and early menopause, which can negatively impact patients’ quality of life—an important treatment goal.

In the United States, 2 gonadotropin-releasing hormone (GnRH) agonists, goserelin and leuprolide, are widely available for ovarian function suppression (OFS) in patients with breast cancer. The ovarian-protective effects of GnRH agonists are mediated by downregulating GnRH receptors in the pituitary gland, which suppresses the release of luteinizing hormone and follicle-stimulating hormone.

In Latin American countries, the onset of breast cancer is approximately 10 years earlier than in high-income countries. Moreover, the incidence rate of breast cancer in individuals aged <40 years is close to 11%, which is higher than the rates in developed regions such as the United States and the European Union. Additionally, most of these young women are diagnosed with advanced-stage disease.