Women who develop breast cancer at age 40 or younger face significant barriers to accessing fertility preservation services. A new global meta-analysis reveals that only one in four accesses these treatments, with wide regional variations.
What was known
Fertility preservation is a crucial aspect of oncological care for young patients, as treatments like chemotherapy can affect reproductive function. However, utilization rates of these services vary widely, and the factors influencing access were not clearly quantified globally.
What this work adds
This is a systematic review and meta-analysis of 18 studies published between January 2010 and August 2026, including 13,394 women aged 40 or younger with breast cancer. Fertility preservation utilization rates and associated factors were evaluated using random-effects models. The certainty of evidence was assessed with the GRADE approach.
Main results
The pooled global fertility preservation utilization rate was 26.8% (95% CI: 20.0-34.1%). Marked regional differences were observed: Europe 47.8%, Asia 19.8%, and North America 14.0%, although the latter estimate was highly imprecise. Factors associated with higher utilization included insurance coverage (OR 2.85), specialist referral (OR 4.26), nulliparity (OR 2.12), being partnered (OR 1.74), higher educational attainment (OR 1.58), and younger age within the young-patient range (OR 0.71).
What it means
Access to fertility preservation appears inequitable worldwide. Although high heterogeneity precludes definitive cross-regional rankings, the findings suggest that healthcare policy reforms expanding insurance coverage and standardizing professional training could improve access. Higher-quality prospective studies are needed to confirm these results.
Reading from the breast unit
In breast units, these data reinforce the importance of integrating early referral to fertility specialists as part of the care pathway for young patients. Incorporating systematic referral protocols and verifying insurance coverage before initiating oncological treatment are measures that can help reduce the observed disparities.
Reference: Yan J, Zhang Y, Yang Z. Global disparities in fertility preservation among young breast cancer patients: a systematic review and meta-analysis of utilization rates and associated factors. Int J Nurs Stud Adv, 2026. DOI
