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The purpose of this study was to compare oncologic outcomes of women with ER+ breast cancer undergoing preoperative COS versus (1) postoperative COS or (2) matched controls not undergoing COS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>This was a single-institution retrospective cohort study of\u00a0women with ER+ breast cancer receiving oncofertility counseling who pursued COS from\u00a02014\u20132024.\u00a0The primary outcome was progression-free survival (PFS). A subcohort of patients who\u00a0received\u00a0neoadjuvant systemic therapy was compared with a matched cohort of similar patients with ER+ breast cancer who did not undergo COS.\u00a0Propensity score matching criteria were age, HER2 receptor status, and clinical stage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 51 women with ER+ breast cancer undergoing COS, the median follow-up was 5.5 years.\u00a05-year PFS was similar for preoperative COS (\n                      <jats:italic>n<\/jats:italic>\n                      = 32) versus postoperative COS (\n                      <jats:italic>n<\/jats:italic>\n                      = 19): 94.1% (95% CI 65.0\u201399.2%) versus 93.3% (95% CI 61.3\u201399.0%),\n                      <jats:italic>p<\/jats:italic>\n                      = 0.73. Patients undergoing neoadjuvant systemic therapy (NST) and preoperative COS (\n                      <jats:italic>n<\/jats:italic>\n                      = 30) experienced a significantly longer time from diagnosis to NST initiation than propensity-score matches who did not undergo COS (48 versus 29.5 days,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.0001), but disease-free survival was similar: 94.1% (95% CI 65.0\u201399.2%) versus 93.3% (95% CI 75.9\u201398.3%),\n                      <jats:italic>p<\/jats:italic>\n                      = 0.15.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this study of women with ER+ breast cancers, preoperative COS was not associated with increased risks of disease progression or death. While COS was associated with a modest delay in NST initiation, PFS was similar to propensity-score matched patients who did not undergo COS. Results support the oncologic safety of COS in the setting of an in situ ER+ tumor and provide much-needed evidence for young women with breast cancer receiving gonadotoxic NST who desire future childbearing during survivorship.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-026-20156-8","type":"journal-article","created":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T22:22:31Z","timestamp":1783203751000},"page":"9899-9909","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Oncologic Safety of Preoperative Controlled Ovarian Stimulation for Fertility Preservation Among Women with Estrogen Receptor Positive Breast Cancer"],"prefix":"10.1245","volume":"33","author":[{"given":"Jennifer H.","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Peregrin-Alvarez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla L.","family":"Warneke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurie J.","family":"McKenzie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terri L.","family":"Woodard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen M.","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,5]]},"reference":[{"issue":"6","key":"20156_CR1","doi-asserted-by":"publisher","first-page":"443","DOI":"10.3322\/caac.21637","volume":"70","author":"KD Miller","year":"2020","unstructured":"Miller KD, Fidler-Benaoudia M, Keegan TH, Hipp HS, Jemal A, Siegel RL. 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The authors have no relevant disclosures.","order":1,"name":"Ethics","label":"Disclosure","group":{"name":"EthicsHeading","label":"Ethics"}}]}}