title: Facilitating reproductive choices: the impact of health services on the experiences of young women with breast cancer.
abstract: OBJECTIVE
  Chemotherapy and hormone treatments carry significant implications on the fertility of young women with breast cancer. Increasingly, nulliparous women experience fertility dilemmas due to rising survival rates and pregnancy delay. This qualitative study investigated women's responses to being told that treatments affected their fertility and how their interactions with health services impacted on their experiences.
  
  
  METHODS
  Twenty-four women under 40 years participated in three focus groups using a flexible interview structure. Data were analysed using content analysis and participants subsequently member checked the themes generated.
  
  
  RESULTS
  The priority for most women was survival, although women without children were more willing to take risks. Many women felt that pregnancy after breast cancer and methods of egg harvesting carried a significant risk to survival and fears appeared to be increased by conflicting advice from health professionals. Overall, the women felt the cancer, its treatment options and the health service itself had each robbed them of choice. Hence, with hindsight, many said they would have welcomed an open and honest discussion with a fertility expert to maximise their options.
  
  
  CONCLUSIONS
  Young women with breast cancer face complex decisions regarding their fertility and treatment options. Survival remains the priority for the majority of women. Although there is a paucity of evidence concerning many fertility issues, it is essential that available options and any potential risks are discussed in a coherent, objective fashion. Early referral to specialist fertility services that provide clear, cohesive advice can aid informed decision making.
authors.affiliation: Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Lee
authors.forename: Ann
authors.initials: A
authors.lastname: Wakefield
authors.forename: Sharon
authors.initials: S
authors.lastname: Foy
authors.forename: Sacha J
authors.initials: SJ
authors.lastname: Howell
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Wardley
authors.forename: Anne C
authors.initials: AC
authors.lastname: Armstrong
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000523:psychology*; D002755:Choice Behavior; D005260:Female; D005298:Fertility; D017144:Focus Groups; D006296:Health Services; D006801:Humans; D012098:Reproduction; D043762:Reproductive Behavior / Q000523:psychology*; D012309:Risk-Taking; D055815:Young Adult