Fertility preservation in young women with breast cancer: a narrative review of effectiveness, oncologic safety, and clinical practice implications

Introduction

Background

The incidence of breast cancer among young women is substantially lower than that observed in women aged over 40 years, corresponding to approximately 6 to 10 cases per 100,000 women, with variation according to geographic region and level of socioeconomic development (1). Despite its higher overall prevalence in older age groups, breast cancer remains the most frequently diagnosed malignant tumor in women of reproductive age, with approximately 10.5% of newly diagnosed cases occurring annually in patients younger than 45 years (2). In parallel with the global trend toward delayed childbearing, an increasing number of young women are being diagnosed and treated for breast cancer before their first pregnancy (3). At the moment of cancer diagnosis, nearly half of young women with breast cancer express a desire to conceive after the completion of treatment. Nevertheless, among female cancer survivors, those with breast cancer experience the lowest likelihood of achieving a subsequent pregnancy, with rates approximately 67% lower than those observed in the general population, even after adjustment for age, educational attainment, and prior parity (4).

Breast cancer in this population is more often characterized by unfavorable pathological features, including high histological grade, lymphovascular invasion, and perineural invasion, as well as a higher prevalence of aggressive molecular subtypes. Luminal B tumors, which represent the most common subtype among young women, along with HER2-positive and triple-negative breast cancers, are disproportionately represented in this age group. Racial disparities in incidence and tumor biology have also been reported, with women of African ancestry exhibiting a higher prevalence of triple-negative breast cancer compared with White women (5,6).

Hereditary predisposition to breast cancer is more frequent among younger women, posing additional challenges in the management of future cancer risk. Beyond oncologic outcomes, young women diagnosed with breast cancer face a distinct set of age-related concerns, including fertility preservation (FP), body image, and sexual dysfunction. These issues contribute to an increased risk of psychological distress both at the time of diagnosis and throughout long-term survivorship, underscoring the need for comprehensive, multidisciplinary care tailored to this population (7,8).

Advances in breast cancer detection and treatment have led to substantial improvements in survival among young women, shifting the clinical focus toward long-term outcomes and survivorship-related quality of life. FP has emerged as a particularly important concern in this population, as commonly used cancer treatments, especially chemotherapy and radiotherapy, are associated with significant gonadotoxic effects that may result in premature ovarian insufficiency, early menopause, and permanent infertility (9,10). For young women, the potential loss of reproductive potential represents not only a biological consequence of treatment but also a major psychosocial burden that can influence treatment decisions, survivorship experiences, and overall well-being.

The impact of breast cancer treatment on fertility is highly variable and depends on patient-related factors, such as age at diagnosis and baseline ovarian reserve, as well as treatment-related characteristics, including regimen type, cumulative dose, and duration of therapy (10,11). Consequently, early fertility risk assessment and timely counseling are now recognized as integral components of high-quality, patient-centered oncologic care. The development of oncofertility as a multidisciplinary field bridging oncology and reproductive medicine has been instrumental in translating reproductive technologies into the cancer care setting, ensuring that FP options are discussed before the initiation of potentially gonadotoxic treatments.

Multiple FP strategies are currently available, with differing levels of clinical maturity and evidence support. Embryo and oocyte cryopreservation are considered standard-of-care approaches, with vitrification techniques yielding high survival and pregnancy rates (12). Pharmacologic ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) during chemotherapy has demonstrated effectiveness in reducing the risk of chemotherapy-induced ovarian failure and is often used as an adjunct strategy, although its role as a sole FP method remains controversial (12,13). Ovarian tissue cryopreservation (OTC) has expanded FP options for prepubertal patients and for women who cannot delay systemic therapy, while emerging approaches such as in vitro maturation (IVM) and experimental regenerative technologies are under active investigation (11).

Rationale and knowledge gap

The risk of treatment-related infertility among young women with breast cancer is a major concern in survivorship, and oncofertility counseling is strongly recommended in multiple clinical guidelines. However, an important gap in oncofertility care persists, namely the lack of consistent access to accurate information regarding infertility risks and available FP options. In addition, financial barriers and limited availability of FP methods represent significant obstacles for patients with breast cancer, both of which vary substantially across regions (14).

Both the American Society of Clinical Oncology (ASCO) and European Society for Medical Oncology (ESMO) clinical practice guidelines consistently recommend that FP counseling and referral be systematically incorporated into the initial management of reproductive-aged, post-pubertal patients with breast cancer, endorsing embryo and oocyte cryopreservation as standard-of-care options, supporting the use of aromatase inhibitor-based ovarian stimulation protocols in hormone receptor-positive disease as oncologically safe, and recognizing temporary ovarian suppression with GnRHa during chemotherapy as a strategy to reduce the risk of premature ovarian insufficiency, without replacing established cryopreservation techniques or compromising cancer outcomes (15,16).

Despite guideline recommendations, important uncertainties remain in the evidence base. Although several systematic reviews and meta-analyses have examined FP strategies in young women with breast cancer, their conclusions differ regarding reproductive effectiveness and oncologic safety. Inconsistencies are particularly evident in the interpretation of live birth rates versus surrogate measures of ovarian function recovery, in the estimated benefit of GnRH agonists during chemotherapy, and in the long-term safety of controlled ovarian stimulation (COS) in hormone receptor-positive disease. Moreover, heterogeneity in patient characteristics, treatment regimens, follow-up duration, and outcome definitions limits comparability across studies and complicates clinical interpretation.

In addition, reproductive and oncologic outcomes are frequently reported in isolation, hindering integrated risk-benefit assessment. Potential selection biases in observational data, including the “healthy mother effect”, further challenge causal interpretation. Variability in methodological quality and overlap of primary studies across reviews may also contribute to apparent concordance or discordance in pooled findings (17).

Taken together, these limitations underscore the need for a structured synthesis that clarifies areas of agreement, identifies sources of heterogeneity, and delineates where evidence is robust versus uncertain, to better inform clinical practice and future research priorities.

Objective

The primary objective of this narrative review is to critically synthesize and integrate available evidence on FP strategies for young women diagnosed with breast cancer. Secondary objectives are to: (I) compare reproductive outcomes across FP methods; (II) examine the timing of interventions relative to cancer treatment; and (III) evaluate oncologic safety outcomes, including recurrence, disease-free survival (DFS), and overall survival (OS). We present this article in accordance with the Narrative Review reporting checklist (available at https://atm.amegroups.com/article/view/10.21037/atm-2026-1-0016/rc).

Methods

Methodological approach

This narrative review aimed to provide a structured synthesis of published systematic reviews examining FP strategies in young women with breast cancer, with particular emphasis on reproductive effectiveness and oncological safety outcomes, rather than to conduct a formal umbrella review with quantitative reclassification of evidence.

Search strategy

A structured literature search was conducted in PubMed/MEDLINE and Web of Science from database inception to December 2025. The search strategy (Table 1) used the terms as follows: (“fertility preservation” OR “oncofertility”) AND “breast cancer” AND (“systematic review” OR “meta-analysis”). Searches were restricted to English-language publications. Reference lists of eligible reviews were additionally screened to identify relevant publications not captured in the primary database search.

Eligibility criteria

Eligible studies were systematic reviews, with or without meta-analysis, that focused exclusively on FP strategies in women diagnosed with breast cancer. Reviews were required to address at least one of the following domains:

• FP methods (e.g., ovarian suppression, oocyte or embryo cryopreservation, ovarian tissue preservation);
• reproductive outcomes (e.g., pregnancy or live birth rates);
• oncological safety outcomes (e.g., recurrence, DFS, OS).

Study selection and data extraction

Two reviewers (A.P.D.L. and M.E.A.P.R.) independently screened titles and abstracts to determine eligibility. Full texts were assessed when necessary to confirm inclusion criteria. Discrepancies were resolved through discussion and consensus among the reviewers.

Data were extracted using a predefined abstraction framework aligned with the objectives of this review. Extracted variables included first author, year of publication, number and type of primary studies included, FP strategies evaluated, characteristics of the study populations, and reported reproductive and oncological safety outcomes.

Overlap of primary studies

The overlap of primary studies across the included reviews was quantified using the corrected covered area (CCA), as described by Pieper et al. (18). Overlap was interpreted using established thresholds: 0–5% (slight), 6–10% (moderate), 11–15% (high), and >15% (very high). Given heterogeneity in study designs and outcome definitions, no quantitative re-synthesis was performed. Findings were integrated through structured qualitative synthesis emphasizing methodological variability, areas of consistency, and clinical implications.

Results

Review of the evidence

The review included a total of 16 articles (Figure 1). The temporal distribution of publications spanned from 2009 to 2025, with the highest concentration of studies published in 2023 (n=4), followed by 2016 and 2025 (n=3), 2022 (n=2), and single publications in 2009, 2014, 2017, and 2018, reflecting increasing scientific interest in FP in recent years. The 16 reviews comprised 207 primary study occurrences corresponding to 136 unique primary studies. The calculated CCA was 8.7%, which indicates a moderate degree of overlap according to the classification proposed by Pieper et al. (18). The studies most frequently included across the reviews were Del Mastro et al., 2011 (19) (10 reviews), Gerber et al., 2011 (20) (9 reviews), and Munster et al., 2012 (21) (8 reviews), reflecting their central role in the evidence base and contributing to the observed overlap.

Figure 1 Study selection flowchart. FP, fertility preservation.

FP methods and outcomes

Across the included studies, FP strategies for premenopausal women with breast cancer comprised (I) temporary ovarian suppression with GnRHa during chemotherapy; (II) COS followed by oocyte or embryo cryopreservation; and (III) alternative approaches such as OTC and IVM performed before systemic therapy (Table 2). All studies focused on premenopausal women, except for Chen et al. [2025], which also included perimenopausal patients (22).

Hormonal FP: GnRH agonists during chemotherapy

Temporary ovarian suppression with GnRHa during chemotherapy was the most extensively investigated FP strategy and demonstrated consistent effectiveness in preserving ovarian function and improving reproductive outcomes. Early studies reported heterogeneous findings; Cruz et al. (23) and Vitek et al. (24) observed limited or nonsignificant benefits in ovarian function recovery, reflecting small sample sizes and methodological limitations. However, subsequent large randomized controlled trials, systematic reviews, and meta-analyses provided robust evidence supporting the efficacy of this approach.

Yuan et al. [2023] (25) demonstrated that GnRHa use significantly increased post-treatment pregnancy rates [risk ratio (RR) 1.76, 95% confidence interval (CI): 1.16–2.67], reduced premature ovarian failure (RR 0.42, 95% CI: 0.35–0.51), improved menstrual recovery (RR 1.20, 95% CI: 1.11–1.30), and decreased amenorrhea rates 1–2 years after chemotherapy (RR 0.50, 95% CI: 0.40–0.63). Similarly, Lambertini et al. (26,27) and Munhoz et al. (28) reported significant reductions in chemotherapy-induced ovarian insufficiency and higher post-treatment pregnancy rates with GnRHa administration, without adverse effects on DFS or OS. These findings were corroborated by Silva et al. (29), White et al. (30), Rodgers et al. (31), and Boutas et al. (32).

More recently, Chen et al. (22) further confirmed the effectiveness of goserelin both in combination with chemotherapy and alongside adjuvant endocrine therapy, demonstrating improved ovarian function suppression and preservation, higher rates of hormonal and menstrual recovery, and increased pregnancy rates.

Across studies, younger age (≤40 years) and GnRHa use were consistently associated with improved ovarian function recovery, whereas exposure to taxanes adversely affected this outcome (29).

COS and oocyte or embryo cryopreservation

COS followed by oocyte or embryo cryopreservation before systemic therapy was consistently associated with effective FP and favorable reproductive outcomes. Chen et al. (33) demonstrated that random-start COS protocols yielded oocyte numbers comparable to conventional follicular-phase stimulation, while performing two stimulation cycles significantly increased the total number of retrieved oocytes. The coadministration of letrozole or tamoxifen did not compromise oocyte yield and was associated with lower peak estradiol levels, supporting the safety of these protocols in hormone-sensitive disease.

Rodgers et al. (31) and Yoshida et al. (34) further demonstrated that letrozole- or tamoxifen-based COS protocols yielded similar numbers of retrieved and mature oocytes compared with standard gonadotropin-only regimens, while effectively reducing estrogen exposure.

Ye et al. [2025], in a meta-analysis of 13 cohort studies including 1,654 patients, further refined predictors of ovarian response. Breast cancer susceptibility gene (BRCA) mutation carriers had significantly reduced mature oocyte yield [mean difference (MD) −1.48, 95% CI: −2.63 to −0.34], whereas estrogen receptor-positive patients demonstrated superior ovarian response, with higher antral follicle count (AFC) (MD 1.37, 95% CI: 0.48–2.26) and greater oocyte yield (MD 1.35, 95% CI: 0.67–2.02). These findings highlight the relevance of tumor biology and genetic background in FP outcomes (35).

Among COS-based strategies, embryo cryopreservation emerged as the FP method with the most robust reproductive success. Turan et al. (36) reported clinical pregnancy and live birth rates of 50% and 33%, respectively, among women who underwent embryo transfer after cryopreservation. Similarly, Boutas et al. (32) identified embryo cryopreservation as the most successful FP strategy in terms of pregnancy achievement, reinforcing its role as the preferred option when feasible.

Alternative and emerging FP methods

Alternative FP strategies, including OTC and IVM, were less frequently evaluated but represent important options for selected patients, particularly those who cannot undergo COS or require urgent initiation of chemotherapy. Boutas et al. (32) concluded that OTC is a viable strategy in time-sensitive clinical scenarios, while IVM shows promise as an emerging technique. Nevertheless, these approaches remain supported by more limited evidence and are generally considered adjunctive rather than first-line FP methods.

Collectively, evidence from the included systematic reviews and meta-analyses indicates that FP strategies are effective in preserving ovarian function and reproductive potential in premenopausal women with breast cancer. COS followed by oocyte or embryo cryopreservation yielded the most consistent and robust reproductive outcomes, with embryo cryopreservation demonstrating the highest rates of clinical pregnancy and live birth (32,35). Temporary ovarian suppression with GnRHa emerged as a complementary and broadly applicable strategy, particularly for patients unable to undergo COS, with consistent improvements in menstrual recovery, reductions in premature ovarian insufficiency, and increased post-treatment pregnancy rates (22,25-28). From a translational perspective, these findings support early integration of reproductive counseling into treatment planning discussions, allowing FP strategies to be aligned with tumor biology, treatment intensity, and patient reproductive goals.

Across studies, FP interventions were associated with improved reproductive outcomes, including ovarian function recovery, pregnancy, and live birth. While OTC and IVM expand FP options for selected patients, long-term reproductive outcomes for these approaches remain less well defined. Overall, the synthesized evidence supports the effectiveness and safety of FP strategies and underscores their role as an integral component of comprehensive cancer care for young women with breast cancer.

Delays in chemotherapy initiation associated with FP

FP strategies, particularly oocyte and embryo cryopreservation, play a critical role in the care of young women with breast cancer who wish to maintain their reproductive potential after treatment. Nevertheless, concerns persist that these interventions may delay the initiation of chemotherapy and represent one of the main barriers to the implementation of FP strategies in young women with breast cancer. The magnitude of delay varies according to the method employed. Ovarian suppression with GnRHa can be initiated immediately and does not require postponement of systemic therapy (22-30,32). In contrast, oocyte or embryo cryopreservation requires COS, which typically lasts 10–14 days; however, the introduction of random-start COS protocols allows initiation at any phase of the menstrual cycle, substantially minimizing delays (31,33,34). OTC and IVM can usually be performed without clinically meaningful postponement of chemotherapy, as they do not require full ovarian stimulation and can be scheduled promptly (32). Overall, contemporary evidence suggests that, when appropriately selected and coordinated, FP strategies rarely lead to delays that exceed acceptable oncologic thresholds. These data reinforce that FP should not be viewed as competing with oncologic urgency, but rather as a coordinated component of pre-treatment planning when supported by streamlined referral pathways and institutional protocols.

Oncological safety

A central concern in the implementation of FP strategies for women with breast cancer is the potential impact on disease recurrence and long-term survival. However, across the studies summarized in the compiled evidence, no increase in recurrence risk has been observed with any FP strategy (Table 3). High-quality evidence from randomized controlled trials and meta-analyses consistently demonstrates that temporary ovarian suppression with GnRHa during chemotherapy does not adversely affect DFS or OS (26-28). Long-term follow-up from the PROMISE-GIM6 trial confirmed comparable 5-year DFS rates between patients receiving chemotherapy alone and those treated with chemotherapy plus GnRHa, while the POEMS trial reported significantly improved DFS and OS among patients with hormone receptor-negative tumors receiving GnRHa (25,28). In addition, large pooled analyses further support the oncologic safety of GnRHa use and suggest a potential survival benefit in selected populations (22,25). Similarly, evidence regarding COS and cryopreservation strategies consistently indicates no increase in short- or long-term recurrence risk. Observational and cohort studies demonstrate oncologic safety across diverse subgroups, including women with estrogen receptor-positive disease and BRCA mutation carriers (31,34,36). Importantly, pregnancy after breast cancer treatment has not been associated with inferior DFS, even with extended follow-up periods of up to 10 years, further reinforcing the safety of FP and subsequent childbearing (34,36).

Although some analyses have reported lower recurrence rates among women who underwent FP, this finding is likely influenced by selection bias, as patients with more favorable prognostic characteristics are more likely to pursue FP, whereas those with more advanced disease may be less frequently referred or eligible (30). Earlier systematic reviews, including Cruz et al. (23), highlighted uncertainty regarding recurrence risk due to limited sample sizes and heterogeneous study designs; however, the accumulation of robust randomized evidence and large-scale meta-analyses over the past decade has largely addressed these concerns.

Importantly, Azizi et al. [2022], in a systematic review of 29 studies, reported that pregnancy after breast cancer was not associated with increased recurrence risk. Several included studies observed comparable or improved survival among women who conceived following treatment, with one reporting a 4.8-fold lower mortality risk compared with non-pregnant controls. This apparent survival advantage is likely attributable to selection bias and the “healthy mother effect”, yet the overall body of evidence consistently supports the oncologic safety of post-treatment pregnancy (37).

The potential impact of short delays in chemotherapy initiation associated with FP has also been extensively debated, particularly in hormone-sensitive breast cancer. Current evidence indicates that brief, planned delays, typically limited to a single menstrual cycle, do not compromise oncologic outcomes in early-stage disease (26,27,30). Randomized trials and meta-analyses evaluating GnRHa use during chemotherapy consistently demonstrate no detrimental effect on DFS or OS, supporting the oncologic safety of ovarian function preservation strategies (25,27). Likewise, observational data on letrozole-based COS protocols show no increase in recurrence risk, even in estrogen receptor-positive tumors, further reinforcing the safety of contemporary stimulation approaches (31,35).

Collectively, the available evidence suggests that oncologic outcomes are primarily determined by tumor biology, stage at diagnosis, and treatment-related factors, rather than by FP interventions themselves (32). Accordingly, FP should be considered an integral and safe component of comprehensive cancer care for young women with breast cancer, rather than a competing priority. The consistent absence of increased recurrence risk across established FP strategies provides the necessary evidentiary foundation for oncologists to confidently incorporate reproductive counseling into routine care without compromising oncologic priorities.

Discussion

This narrative review synthesizes evolving evidence on FP strategies for premenopausal women with breast cancer, demonstrating substantial advances in reproductive technology and growing reassurance regarding oncologic safety. While oocyte and embryo cryopreservation remain the most established strategies, OTC has expanded options for patients requiring urgent systemic therapy. Temporary ovarian suppression during chemotherapy represents a complementary protective strategy, although its magnitude of benefit varies according to age, baseline ovarian reserve, and treatment-related factors (38).

Apparent inconsistencies across studies largely reflect methodological and clinical heterogeneity rather than true biological divergence. Chemotherapy regimen composition is a primary determinant of gonadotoxicity. Anthracycline-, taxane-, and alkylating agent-based protocols are consistently associated with significant ovarian reserve depletion, with more than half of survivors demonstrating clinically meaningful reductions in anti-Müllerian hormone (AMH) levels following treatment (39). Dose-dense regimens may intensify ovarian damage independent of age (40). Nonetheless, baseline ovarian reserve and chronological age substantially modify risk, with younger patients exhibiting greater functional resilience (39,41). Failure to stratify by age and treatment intensity limits cross-study comparability and may contribute to discordant effectiveness estimates.

Follow-up duration further shapes the interpretation of effectiveness outcomes. Reproductive success after FP is inherently time-dependent, as many survivors defer pregnancy attempts for several years following completion of cancer therapy. Short follow-up periods may underestimate cumulative pregnancy incidence and the utilization of cryopreserved material, whereas longer observation reveals progressively increasing conception rates (42). Similarly, evaluation of ovarian function preservation strategies, such as GnRHa co-administration during chemotherapy, requires extended longitudinal assessment to determine whether endocrine recovery is durable (38). Without adequate follow-up, both effectiveness and safety conclusions may be prematurely drawn.

Heterogeneity in endpoint definitions also complicates interpretation. Studies variably report pregnancy rates, live birth rates, menstrual recovery, or AMH dynamics. These outcomes capture distinct biological and clinical dimensions and are not interchangeable. Differences in reporting assisted reproductive technology outcomes, per transfer versus cumulative live birth, spontaneous versus assisted conception, further limit comparability (38). Although pregnancy after breast cancer is broadly considered oncologically safe, slightly increased obstetric risks have been described, underscoring the importance of standardized reporting and multidisciplinary management (43).

Selection bias must be considered when interpreting both reproductive and survival outcomes. The “healthy mother effect” likely contributes to observations of comparable or improved survival among women who conceive after breast cancer, as those attempting pregnancy often have favorable tumor biology, preserved ovarian function, and adequate treatment response (17). Without appropriate adjustment for baseline prognostic factors, post-treatment pregnancy outcomes may overestimate both reproductive success and oncologic reassurance.

Beyond biological determinants, structural and systemic factors influence access to FP. Financial barriers, limited awareness, and delayed referral pathways remain important obstacles (10). Multidisciplinary coordination between oncology and reproductive medicine is essential to ensure timely counseling and individualized decision-making (44,45). Translationally, improved integration of ovarian reserve biomarkers, treatment intensity metrics, and patient-centered reproductive goals may enhance risk stratification and shared decision-making.

Taken together, discrepancies in the literature are more plausibly explained by variations in chemotherapy exposure, patient age distribution, follow-up duration, endpoint definition, and selection mechanisms than by contradictory effects of FP strategies themselves. Future research should prioritize harmonized outcome reporting, long-term prospective follow-up, and robust adjustment for prognostic confounders to strengthen the translational bridge between reproductive endocrinology and oncology.

This review has some limitations. Although the CCA indicated a moderate overlap, the recurrence of key primary studies across multiple reviews may have disproportionately influenced the evidence base and should be considered when interpreting the findings. The available literature remains heterogeneous in study design and reporting standards, with live birth outcomes underrepresented compared with surrogate markers of ovarian function. Evidence on OTC and IVM is largely observational, limiting the strength of comparative inferences. In addition, long-term oncologic safety data beyond extended endocrine therapy are scarce. Nevertheless, the convergence of evidence from prospective trials and meta-analyses consistently supports the clinical effectiveness and oncologic safety of established FP strategies in appropriately selected young women with breast cancer. Further efforts toward standardized outcome reporting and long-term prospective registries are warranted to strengthen the evidence base and support integration into routine oncologic care.

Translational implications

The translation of FP evidence into clinical oncology requires structured institutional pathways. Early referral algorithms, standardized counseling frameworks, and integration of reproductive endocrinology within oncology services have been shown to improve uptake of FP strategies. Incorporating ovarian reserve biomarkers, treatment intensity metrics, and tumor biology into individualized counseling may further refine shared decision-making. Importantly, equitable implementation must address financial barriers, geographic disparities, and variability in institutional resources.

Conclusions

This narrative review synthesizes the evolving evidence on FP strategies for premenopausal women with breast cancer, demonstrating a clear progression from early, heterogeneous approaches to well-established and evidence-based interventions. FP methods have shown increasing effectiveness, feasibility, and clinical relevance, supported by advances in reproductive technology and improved understanding of oncologic safety.

Temporary ovarian suppression with GnRHa during chemotherapy has emerged as a widely applicable strategy, associated with higher rates of menstrual recovery, reduced premature ovarian insufficiency, and increased post-treatment pregnancy rates. In parallel, COS followed by oocyte or embryo cryopreservation has become increasingly feasible due to random-start protocols and letrozole- or tamoxifen-based regimens, which effectively limit estrogen exposure without compromising oocyte yield. Among available approaches, embryo cryopreservation demonstrates the strongest evidence for achieving clinical pregnancy and live birth. Alternative strategies, such as OTC and IVM, further expand FP options for selected patients requiring urgent treatment, although long-term outcome data remain limited.

The accumulated evidence supports the oncologic safety and reproductive effectiveness of established FP strategies in young women with breast cancer. The next translational step lies in optimizing implementation, ensuring timely referral, multidisciplinary coordination, and equitable access across healthcare systems. Future research should prioritize harmonized outcome reporting, long-term prospective registries, and integration of biological risk stratification tools to refine personalized FP pathways within modern oncology care.

Acknowledgments

We acknowledge the support from the National Council for Scientific and Technological Development (CNPq), Brazil (No. 306003/2024-4), and Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG), Brazil.

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://atm.amegroups.com/article/view/10.21037/atm-2026-1-0016/rc

Peer Review File: Available at https://atm.amegroups.com/article/view/10.21037/atm-2026-1-0016/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-2026-1-0016/coif). A.P.D.L. serves as an unpaid editorial board member of Annals of Translational Medicine from June 2024 to May 2026. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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