Pregnancy after Breast Cancer: Development of an Oncofertility Program in Japan

The incidence of breast cancer among young women is rising globally, with approximately 4000–5000 women under 40 diagnosed annually in Japan. As cancer prognosis improves, fertility preservation for patients wishing to have children after treatment has gained increased attention. Current guidelines recommend that fertility preservation be offered to these women; however, challenges remain in accessing quality care. This article examines Japan’s oncofertility program, highlighting its challenges and future prospects in the care of young women diagnosed with breast cancer (YWBC). Effective oncofertility programs must provide patients with sufficient information, support for decision-making, and necessary care. Communication among stakeholders, a shared understanding of evidence, and psychological support are fundamental components. Japan’s oncofertility program has evolved to include an oncofertility network, evidence-based guidelines, and an oncofertility registry since the 2010s with government support. Despite experiencing substantial growth, it also faces disparities and obstacles. Significant challenges include the accuracy of information needed for informed decision-making, the accessibility of decision support, and economic factors that affect care. Access to oncofertility care is influenced by healthcare providers’ awareness, knowledge, and counseling skills. Economic disparities further hinder access to fertility preservation. The Japanese National Cancer Control Plan aims to develop a comprehensive oncofertility program, but disparities in information and resources persist, underscoring the need for robust, evidence-based research to support informed decision-making for YWBC.