Structural Determinants of Childbearing Challenges in Breast Cancer Survivorship: A Systematic Review

Behjat Khorsandi; Mahrokh Dolatian; Zoherh Mahmoodi; Mohammad Ali Broomand; Hamid Alavi Majd

doi:10.34172/cjmb.2025.4455

E-ISSN : 2148-9696

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Review
Structural Determinants of Childbearing Challenges in Breast Cancer Survivorship: A Systematic Review
Behjat Khorsandi¹, Mahrokh Dolatian², Zoherh Mahmoodi³, Mohammad Ali Broomand⁴, Hamid Alavi Majd⁵
¹Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran ²Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran ³Social Determinants of Health Research Center, School of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran ⁴Department of Radiation Oncology, Medical School, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran ⁵Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
DOI: 10.34172/cjmb.2025.4455 Viewed : 113 times Downloaded : 112 times. Keywords : Social determinants of health, Structural determinants, Breast cancer, Survivorship, Childbearing, Reproductive behavior
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Abstract

Objectives: A growing number of women of reproductive age are battling breast cancer. The younger the age of the breast cancer, the more aggressive gonadal toxic treatments are needed. A large number of younger women with breast cancer are childless and plan to become pregnant after treatment. Thus, this study aimed to understand the structural determinants of health associated with the challenges these women face as they navigate childbearing after breast cancer treatment. Methods: PubMed, Scopus, Embase and Web of Science were searched up to July 2024. The review was preregistered (PROSPERO: CRD42024502269). We used "Newcastle-Ottawa Scale" for risk of bias assessment of studies. Results: A total of nine studies met the inclusion criteria. They were all of high quality and had little chance of being biased. Breast cancer survivors" reproductive choices and childbearing are influenced by a number of structural determinants of health. These determinants include age, education level, socioeconomic status, housing, race, and ethnicity. Since age was a determinant in seven of eight studies reviewed (the lower the age, the greater the childbearing intention, fertility preservation, counseling, and pregnancy attempt), age appeared to be a more significant and influential factor. Conclusions: This review analysis revealed a connection between the reproductive practices of surviving women and the structural determinants of health and fertility. Reproductive-aged women who have struggled with this condition in the past may face various difficulties because of their fertility problems. Therefore, it seems beneficial to understand these factors and develop strategies to address these obstacles. This will allow these women to live a happy and hopeful life.