More than 32,000 young patients newly diagnosed with cancer now live in states that have imposed or have impending abortion restrictions, according to a new study published Monday in The Lancet Oncology.
Because many life-saving cancer treatments harm future fertility, many teens and young adults with cancer decide to freeze eggs, sperm or embryos in the hope of having a family later in life.
Now, in the wake of the Supreme Court's overturning of Roe v. Wade, the American Cancer Society is warning that their fertility preservation options could be at risk in the future.
Possible ramifications for cancer patients could include potential restrictions on gene testing, storage and disposal of embryos, even those created in the laboratory, according to researchers from the American Cancer Society.
For now, these concerns are hypothetical. Recent legislation has focused primarily on restricting abortion, and laws regarding embryos or other fertility preservation methods are not explicit, according to the Guttmacher Institute, an abortion-rights research organization.
However, Guttmacher and other abortion-rights advocates have raised it as a possibility in the future. And they argue that some state legislation refers to protecting an "unborn child" without clearly defining whether that might include an embryo. That could make it difficult for health care providers to know when they've run afoul of the law, they say.
Researchers at the American Cancer Society studied more than 120,000 young patients between the ages of 15 and 44 who were diagnosed with cancer in 2018, finding that more than 68% needed fertility preservation.
Of those, more than 32,000 patients -- including over 20,000 women -- were from the 22 states where abortion bans exist or are expected to be implemented, the study found. Texas, Ohio and Georgia were the states with the largest number of newly diagnosed young cancer patients whose fertility preservation care could be compromised.
"Ongoing monitoring of the health effects of the Supreme Court decision on cancer patients and their families is warranted," said Xuesong Han, Ph.D., the lead study author, scientific director and health services researcher at the American Cancer Society.
The anti-abortion group Charlotte Lozier Institute called the American Cancer Society's warning misleading.
"A plain reading of state pro-life laws shows this study is nothing more than scaremongering, which is a huge disservice to the medical community and American women," the institute's Tara Sander Lee, Ph.D., said
Researchers found that patients from 22 states with abortion restrictions were more likely to be living in non-metropolitan areas, belonging to the poorest counties, and were of white or Black ethnicities, compared to the patients from 28 states where abortion remained legal.
"We have not yet begun to see exactly how the Dobbs ruling impacts fertility; however, it is clear that there will be a monumental impact," said Dr. Eleonora Teplinsky, head of breast medical oncology at Valley Health System and a clinical assistant professor of medicine at the Icahn School of Medicine at Mount Sinai.
Fertility preservation, though possible in a less restrictive state, will create new barriers and could widen geographic and socioeconomic disparities, according to the study.
"Traveling to another state to get fertility care will put undue burden especially on the most vulnerable of these patients -- medical, financial and psychological," said Dr. Sunita Nasta, professor of clinical medicine at the Abramson Cancer Center at the University of Pennsylvania, adding that "compromised access to care leads to worse outcomes."
"The treatment of aggressive cancers is usually urgent. Fertility preservation needs to be accomplished within a few days to weeks. If these procedures are limited by these bans, patients will face the burden of losing their fertility or delaying therapy," Nasta said.
"Many patients make treatment decisions based on fertility concerns. If fertility preservation is further endangered as we suspect it will be, we likely will begin to see even more patients choosing not to go on life-saving cancer therapy," Teplinsky said.
"The ability to protect their choices with appropriate fertility care gives these patients the freedom to be aggressive about choosing therapy for the best outcomes rather than what may affect their future fertility," Nasta added.
Khushali Jhaveri, MD, a board-certified internal medicine physician, is a hematology/oncology fellow at Moffitt Cancer Center and is a member of the ABC News Medical Unit.