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Roberts JE, Benoit J, Foong S, Saumet J, Korkidakis A, Marr K, McQuillan S, Todd N. Fertility preservation in patients undergoing gonadotoxic treatments: a Canadian Fertility and Andrology Society clinical practice guideline. Reprod Biomed Online 2024; 48:103767. [PMID: 38458057 DOI: 10.1016/j.rbmo.2023.103767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 03/10/2024]
Abstract
The management of young patients with cancer presents several unique challenges. In general, these patients are ill prepared for the diagnosis and the impact on their fertility. With the improved survival for all tumour types and stages, the need for adequate fertility counselling and a multidisciplinary approach in the reproductive care of these patients is paramount. Recent advances in cryopreservation techniques allow for the banking of spermatozoa, oocytes, embryos and ovarian tissue without compromising survival. This Canadian Fertility and Andrology Society (CFAS) guideline outlines the current understanding of social and medical issues associated with oncofertility, and the medical and surgical technologies available to optimize future fertility.
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Affiliation(s)
- Jeffrey E Roberts
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, B.C., Canada.
| | - Janie Benoit
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Shu Foong
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - Julio Saumet
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Ann Korkidakis
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard University, Boston, MA, USA
| | - Kristin Marr
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, B.C., Canada
| | - Sarah McQuillan
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - Nicole Todd
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, B.C., Canada
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Cui W, Rocconi RP, Thota R, Anderson RA, Bruinooge SS, Comstock IA, Denduluri N, Gassman A, Gralow J, Hutt KJ, Amiri-Kordestani L, Lambertini M, Leighton J, Lu KH, Mostoufi-Moab S, Pollastro T, Pradhan S, Saber H, Schenkel C, Spratt D, Wedam S, Phillips KA. Measuring ovarian toxicity in clinical trials: an American Society of Clinical Oncology research statement. Lancet Oncol 2023; 24:e415-e423. [PMID: 37797647 DOI: 10.1016/s1470-2045(23)00390-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 10/07/2023]
Abstract
Anticancer agents can impair ovarian function, resulting in premature menopause and associated long-term health effects. Ovarian toxicity is not usually adequately assessed in trials of anticancer agents, leaving an important information gap for patients facing therapy choices. This American Society of Clinical Oncology (ASCO) statement provides information about the incorporation of ovarian toxicity measures in trial design. ASCO recommends: (1) measurement of ovarian toxicity in relevant clinical trials of anticancer agents that enrol post-pubertal, pre-menopausal patients; (2) collection of ovarian function measures at baseline and at 12-24 months after anticancer agent cessation, as a minimum, and later in line with the trial schedule; and (3) assessment of both clinical measures and biomarkers of ovarian function. ASCO recognises that routine measurement of ovarian toxicity and function in cancer clinical trials will add additional complexity and burden to trial resources but asserts that this issue is of such importance to patients that it cannot continue to be overlooked.
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Affiliation(s)
- Wanda Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Rodney P Rocconi
- The University of Mississippi Medical Center, Cancer Center & Research Institute, Jackson, MS, USA
| | | | - Richard A Anderson
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | | | - Ioanna A Comstock
- Office of Rare Diseases, Pediatrics, Urologic and Reproductive Medicine, Division of Urology, Obstetrics, and Gynecology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Audrey Gassman
- Office of Rare Diseases, Pediatrics, Urologic and Reproductive Medicine, Division of Urology, Obstetrics, and Gynecology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Julie Gralow
- American Society of Clinical Oncology, Alexandria, VA, USA
| | - Karla J Hutt
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Laleh Amiri-Kordestani
- Division of Oncology 1, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genoa, Italy; Department of Medical Oncology, UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - John Leighton
- Division of Hematology Oncology Toxicity, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sogol Mostoufi-Moab
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Shan Pradhan
- Office of Oncologic Diseases, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Haleh Saber
- Division of Hematology Oncology Toxicity, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Daniel Spratt
- Moffitt Cancer Center and Research Institute, Cleveland, OH, USA
| | - Suparna Wedam
- Division of Oncology 1, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
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Abraham M, Lak MA, Gurz D, Nolasco FOM, Kondraju PK, Iqbal J. A Narrative Review of Breastfeeding and Its Correlation With Breast Cancer: Current Understanding and Outcomes. Cureus 2023; 15:e44081. [PMID: 37750138 PMCID: PMC10518059 DOI: 10.7759/cureus.44081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
Breastfeeding has been extensively studied in relation to breast cancer risk. The results of the reviewed studies consistently show a decreased risk of breast cancer associated with breastfeeding, especially for 12 months or longer. This protective effect is attributed to hormonal, immunological, and physiological changes during lactation. Breastfeeding also appears to have a greater impact on reducing breast cancer risk in premenopausal women and specific breast cancer subtypes. Encouraging breastfeeding has dual benefits: benefiting infants and reducing breast cancer risk long-term. Healthcare professionals should provide evidence-based guidance on breastfeeding initiation, duration, and exclusivity, while public health policies should support breastfeeding by creating enabling environments. This review examines the existing literature and analyzes the correlation between breastfeeding and breast cancer risk.
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Affiliation(s)
- Merin Abraham
- Department of Internal Medicine, Kasturba Medical College, Manipal, IND
| | - Muhammad Ali Lak
- Department of Internal Medicine, Combined Military Hospital, Lahore, PAK
| | - Danyel Gurz
- Department of Internal Medicine, Combined Military Hospital, Lahore, PAK
| | | | | | - Javed Iqbal
- Department of Neurosurgery, Mayo Hospital, Lahore, PAK
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Yildiz S, Bildik G, Benlioglu C, Turan V, Dilege E, Ozel M, Kim S, Oktem O. Breast cancer treatment and ovarian function. Reprod Biomed Online 2023; 46:313-331. [PMID: 36400663 DOI: 10.1016/j.rbmo.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 02/07/2023]
Abstract
The aim of this study was to provide an update on ovarian function and the mechanisms of gonadal damage after exposure to chemotherapy in breast cancer survivors. The alkylating agents are toxic to both primordial and growing follicles. However, anti-metabolite drugs are more likely to destroy preantral and antral follicles. Younger patients are more likely to have a higher ovarian reserve, and therefore, more likely to retain some residual ovarian function after exposure to gonadotoxic regimens. However, there can be significant variability in ovarian reserve among patients of the same age. Furthermore, patients with critically diminished ovarian reserve may continue to menstruate regularly. Therefore age and menstrual status are not reliable indicators of good ovarian reserve and might give a false sense of security and result in an adverse outcome if the patient is consulted without considering more reliable quantitative markers of ovarian reserve (antral follicle count and anti-Müllerian hormone) and fertility preservation is not pursued. In contrast to well-documented ovarian toxicity of older chemotherapy regimens, data for newer taxane-containing protocols have only accumulated in the last decade and data are still very limited regarding the impact of targeted therapies on ovarian function.
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Affiliation(s)
- Sule Yildiz
- The Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Koç University Hospital, Koç University School of Medicine, Istanbul, Turkey
| | - Gamze Bildik
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston TX 77054, USA
| | - Can Benlioglu
- Department of Obstetrics and Gynecology, Koç University Hospital, Istanbul, Turkey
| | - Volkan Turan
- Istanbul Tema Hospital, Assisted Reproduction Unit, Istanbul
| | - Ece Dilege
- Department of General Surgery, Koç University Hospital, Koç University School of Medicine, Istanbul, Turkey
| | - Melis Ozel
- Department of Gynecology and Obstetrics Klinikum Ingolstadt, Bavaria, Germany
| | - Samuel Kim
- Eden Centers for Advanced Fertility, Fullerton CA 92835, USA
| | - Ozgur Oktem
- The Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Koç University Hospital, Koç University School of Medicine, Istanbul, Turkey.
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Cioffi R, Cervini L, Taccagni G, Papaleo E, Pagliardini L, Bergamini A, Ferrari S, Mangili G, Candiani M. A prospective, observational study of chemotherapy-induced ovarian damage on follicular reserve and maturation. Arch Gynecol Obstet 2022; 306:1723-1729. [PMID: 35833992 DOI: 10.1007/s00404-022-06692-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chemotherapy negatively affects gonadal function, often resulting in premature ovarian failure (POF) due to ovarian reserve depletion. Mechanisms of gonadotoxicity, such as primordial follicle overactivation and "burnout", remain to be established. Ovarian tissue cryopreservation (OTC) before treatment plays an important role in safeguarding fertility. METHODS This is a prospective observational study that aims to evaluate the feasibility of OTC after chemotherapeutic treatment initiation. Patients were divided into 2 groups depending on whether they received chemotherapy before the harvesting procedure (Group 1) or not (Group 2). The main outcomes of this study are serum anti-Mullerian hormone (AMH) levels and histological follicular counts on ovarian tissue biopsies. RESULTS Between 2012 and 2020, 79 patients underwent OTC at our Hospital. Follicular counts from the ovarian biopsies of 30 post-pubertal patients and respective serum AMH levels were included in the analysis. AMH levels did not significantly differ between the 2 groups (P = 0.70) as well as the number of primordial follicles (P = 0.73). Ovarian biopsies of patients from Group 1 showed a higher number of primary follicles (P = 0.04) and atretic follicles (P = 0.05) with respect to Group 2. CONCLUSIONS In conclusion, OTC appears to be feasible even after the start of chemotherapeutic treatment, since in treated patients, the main ovarian reserve indicators (number of primordial follicles and serum AMH levels) were not significantly reduced compared to untreated patients. The "burnout" theory of chemotherapeutic damage to the ovary seems to be supported by the higher number of primary follicles found in the ovaries of patients who received chemotherapy before OTC.
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Affiliation(s)
- Raffaella Cioffi
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Laura Cervini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Gianluca Taccagni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Papaleo
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Luca Pagliardini
- Division of Genetics and Cell Biology, Reproductive Sciences Laboratory, San Raffaele Scientific Institute, Milan, Italy
| | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Stefano Ferrari
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Massimo Candiani
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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Kumar P, Rao S, Mundkur A, Adiga P, Poojari VG, Ullagaddi RK. Random Start Ovarian Stimulation. J Hum Reprod Sci 2022; 15:200-203. [PMID: 35928466 PMCID: PMC9345281 DOI: 10.4103/jhrs.jhrs_172_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 05/21/2022] [Accepted: 05/26/2022] [Indexed: 11/08/2022] Open
Abstract
Fertility preservation is emerging in recent years as an important option for various indications many of which being for cancer patients and for certain benign conditions as well. In the present case report, we set out to utilise the same protocol, however, for different indications.
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Affiliation(s)
- Pratap Kumar
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
| | - Shubha Rao
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
| | - Anjali Mundkur
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
| | - Prashanth Adiga
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
| | - Vidyashree G Poojari
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
| | - Rashmi K Ullagaddi
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
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Roine E, Sintonen H, Kellokumpu-Lehtinen PL, Penttinen H, Utriainen M, Vehmanen L, Huovinen R, Kautiainen H, Nikander R, Blomqvist C, Hakamies-Blomqvist L, Saarto T. Long-term health-related quality of life of breast cancer survivors remains impaired compared to the age-matched general population especially in young women. Results from the prospective controlled BREX exercise study. Breast 2021; 59:110-116. [PMID: 34225091 PMCID: PMC8264211 DOI: 10.1016/j.breast.2021.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate long-term health-related quality of life (HRQoL) changes over time in younger compared to older disease-free breast cancer survivors who participated in a prospective randomized exercise trial. METHODS Survivors (aged 35-68 years) were randomized to a 12-month exercise trial after adjuvant treatment and followed up for ten years. HRQoL was assessed with the generic 15D instrument during follow-up and the younger (baseline age ≤ 50) and older (age >50) survivors' HRQoL was compared to that of the age-matched general female population (n = 892). The analysis included 342 survivors. RESULTS The decline of HRQoL compared to the population was steeper and recovery slower in the younger survivors (p for interaction < 0.001). The impairment was also larger among the younger survivors (p = 0.027) whose mean HRQoL deteriorated for three years after treatment and started to slowly improve thereafter but still remained below the population level after ten years (difference -0.017, 95% CI: -0.031 to -0.004). The older survivors' mean HRQoL gradually approached the population level during the first five years but also remained below it at ten years (difference -0.019, 95% CI: -0.031 to -0.007). The largest differences were on the dimensions of sleeping and sexual activity, on which both age groups remained below the population level throughout the follow-up. CONCLUSIONS HRQoL developed differently in younger and older survivors both regarding the most affected dimensions of HRQoL and the timing of the changes during follow-up. HRQoL of both age groups remained below the population level even ten years after treatment.
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Affiliation(s)
- Eija Roine
- Helsinki University Hospital, Comprehensive Cancer Center, and University of Helsinki, Faculty of Medicine, Helsinki, Finland.
| | - Harri Sintonen
- University of Helsinki, Department of Public Health, Helsinki, Finland
| | - Pirkko-Liisa Kellokumpu-Lehtinen
- Tampere University, Faculty of Medicine and Medical Technology, and Tampere University Hospital, Cancer Center, Center of Research, Development and Innovation, Tampere, Finland
| | - Heidi Penttinen
- Helsinki University Hospital, Comprehensive Cancer Center, and University of Helsinki, Faculty of Medicine, Helsinki, Finland
| | - Meri Utriainen
- Helsinki University Hospital, Comprehensive Cancer Center, and University of Helsinki, Faculty of Medicine, Helsinki, Finland
| | - Leena Vehmanen
- Helsinki University Hospital, Comprehensive Cancer Center, and University of Helsinki, Faculty of Medicine, Helsinki, Finland
| | - Riikka Huovinen
- Turku University Hospital, Department of Oncology, and University of Turku, Faculty of Medicine, Turku, Finland
| | - Hannu Kautiainen
- Kuopio University Hospital, Primary Health Care Unit, Kuopio, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Riku Nikander
- University of Jyväskylä, Faculty of Sport and Health Sciences, GeroCenter Foundation for Aging Research & Development, and Central Finland Hospital District, Department of Research & Education, Jyväskylä, Finland
| | - Carl Blomqvist
- Helsinki University Hospital, Comprehensive Cancer Center, and University of Helsinki, Faculty of Medicine, Helsinki, Finland; Örebro University Hospital, Department of Oncology, Örebro, Sweden
| | - Liisa Hakamies-Blomqvist
- Helsinki University Hospital, Comprehensive Cancer Center, and University of Helsinki, Faculty of Medicine, Helsinki, Finland
| | - Tiina Saarto
- Helsinki University Hospital, Comprehensive Cancer Center, and University of Helsinki, Faculty of Medicine, Helsinki, Finland
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Ruddy KJ, Zheng Y, Tayob N, Hu J, Dang CT, Yardley DA, Isakoff SJ, Valero VV, Faggen MG, Mulvey TM, Bose R, Sella T, Weckstein DJ, Wolff AC, Reeder-Hayes KE, Rugo HS, Ramaswamy B, Zuckerman DS, Hart LL, Gadi VK, Constantine M, Cheng KL, Briccetti FM, Schneider BP, Merrill Garrett A, Kelly Marcom P, Albain KS, DeFusco PA, Tung NM, Ardman BM, Nanda R, Jankowitz RC, Rimawi M, Abramson V, Pohlmann PR, Van Poznak C, Forero-Torres A, Liu MC, Rosenberg S, DeMeo MK, Burstein HJ, Winer EP, Krop IE, Partridge AH, Tolaney SM. Chemotherapy-related amenorrhea (CRA) after adjuvant ado-trastuzumab emtansine (T-DM1) compared to paclitaxel in combination with trastuzumab (TH) (TBCRC033: ATEMPT Trial). Breast Cancer Res Treat 2021; 189:103-110. [PMID: 34120223 DOI: 10.1007/s10549-021-06267-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Chemotherapy-related amenorrhea (CRA) is a surrogate for ovarian toxicity and associated risk of infertility and premature menopause. Here, we compare CRA rate with paclitaxel (T)-trastuzumab (H) to that with ado-trastuzumab emtansine (T-DM1). METHODS Patients with T1N0 HER2 + early-stage breast cancer (eBC) enrolled on the ATEMPT trial and were randomized 3:1 to T-DM1 3.6 mg/kg IV every (q) 3 weeks (w) × 17 vs. T 80 mg/m2 with H IV qw × 12 (4 mg/kg load → 2 mg/kg), followed by H (6 mg/kg IV q3w × 13). Enrollees who self-reported as premenopausal were asked to complete menstrual surveys at baseline and every 6-12 months for 60 months. 18-month CRA (no periods reported during prior 6 months on 18-month survey) was the primary endpoint of this analysis. RESULTS Of 512 ATEMPT enrollees, 123 who began protocol therapy and answered baseline and at least one follow-up menstrual survey were premenopausal at enrollment. 76 had menstrual data available at 18 months without having received a gonadotropin-releasing hormone agonist or undergone hysterectomy and/or oophorectomy. Median age was 45 (range 23-53) among 18 who had received TH and 46 (range 34-54) among 58 who had received T-DM1. The 18-month rate of CRA was 50% after TH and 24% after T-DM1 (p = 0.045). CONCLUSION Amenorrhea at 18 months was less likely in recipients of adjuvant T-DM1 than TH. Future studies are needed to understand how T-DM1 impacts risk of infertility and permanent menopause, and to assess amenorrhea rates when T-DM1 is administered after standard HER2-directed chemotherapy regimens.
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Affiliation(s)
- Kathryn J Ruddy
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Yue Zheng
- Dana-Farber Cancer Institute, Boston, USA
| | | | - Jiani Hu
- Dana-Farber Cancer Institute, Boston, USA
| | - Chau T Dang
- Memorial Sloan Kettering Cancer Center, New York, USA
| | | | | | | | | | | | - Ron Bose
- Siteman Cancer Center, St. Louis, USA
| | - Tal Sella
- Dana-Farber Cancer Institute, Boston, USA
| | | | | | | | - Hope S Rugo
- Diller Family Comprehensive Cancer Center, University of California San Francisco Helen, San Francisco, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rachel C Jankowitz
- Penn Medicine Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Mothaffar Rimawi
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | | | - Paula R Pohlmann
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | | | | | - Minetta C Liu
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | | | | | - Ian E Krop
- Dana-Farber Cancer Institute, Boston, USA
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Shapiro CL. Bone-modifying Agents (BMAs) in Breast Cancer. Clin Breast Cancer 2021; 21:e618-e630. [PMID: 34045175 DOI: 10.1016/j.clbc.2021.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 12/13/2022]
Abstract
Bone-modifying agents (BMAs) are mainstays in breast cancer and prevent and treat osteoporosis in early-stage disease and reduce skeletal metastases complications in advanced disease. There is some evidence to support that BMA also prevents skeletal metastases and improves overall survival. Bone loss occurs with chemotherapy-induced ovarian failure, gonadotrophin-releasing hormone (GnRH) agonists, and aromatase inhibitors. In some women, the bone loss will be of sufficient magnitude to increase the risks of osteoporosis or fractures. Recommended steps in osteoporosis prevention or treatment include risk factor assessment, taking adequate amounts of calcium and vitamin D3, and periodic evaluations with dual-energy x-ray absorptiometry scanning. If clinically indicated by the T-scores and fracture-risk prediction algorithms treat with oral, IV bisphosphonates or subcutaneous denosumab (DEN). Zoledronic acid (ZA) or DEN reduces skeletal metastases complications, including pathological fracture, spinal cord compression, or the necessity for radiation or surgery to bone. Also, both of these drugs have the side-effect of osteonecrosis at a similar incidence. Monthly administration of ZA or DEN is standard, but several recent randomized trials show noninferiority between ZA monthly and every 3-month ZA. Every 3-month ZA is a new standard of care. Similar trials of the schedule of DEN are ongoing. ZA anticancer effect is only in postmenopausal women or premenopausal women rendered postmenopausal by GnRH agonists or bilateral oopherectomy. High-risk women, either postmenopausal or premenopausal, receiving GnRH/oopherctomy should consider adjuvant ZA. There are insufficient data to support DEN in this setting. Herein, this narrative review covers the mechanism of action of BMA, randomized clinical trials, and adverse events, both common and rare.
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10
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Brancati S, Gozzo L, Longo L, Vitale DC, Russo G, Drago F. Fertility Preservation in Female Pediatric Patients With Cancer: A Clinical and Regulatory Issue. Front Oncol 2021; 11:641450. [PMID: 33796467 PMCID: PMC8008167 DOI: 10.3389/fonc.2021.641450] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/29/2021] [Indexed: 12/22/2022] Open
Abstract
Fertility preservation represents one important goal of cancer patients’ management due to the high impact on health and quality of life of survivors. The available preventive measures cannot be performed in all patients and are not feasible in all health-care facilities. Therefore, the pharmacological treatment with GnRHa has become a valuable non-invasive and well-tolerated alternative, especially in those who cannot access to cryopreservation options due to clinical and/or logistic issues. Supporting data demonstrate a significant advantage for the survivors who received GnRHa in the long-term maintenance of ovarian function and preservation of fertility. The prevention of the risk of ovarian failure with GnRHa is a typical off-label use, defined as the administration of a medicinal product not in accordance with the authorized product information. Italy has officially recognized the off-label use of GnRHa in adult women at risk of premature and permanent menopause following chemotherapy. However, fertility preservation still represents an unmet medical need in adolescents who cannot access to other treatment options.
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Affiliation(s)
- Serena Brancati
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
| | - Lucia Gozzo
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy.,Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Laura Longo
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
| | - Daniela Cristina Vitale
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
| | - Giovanna Russo
- Pediatric Onco-Hematology, University Hospital of Catania, Catania, Italy
| | - Filippo Drago
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy.,Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.,Centre for Research and Consultancy in HTA and drug Regulatory Affairs (CERD), University of Catania, Catania, Italy
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Osteoporosis: A Long-Term and Late-Effect of Breast Cancer Treatments. Cancers (Basel) 2020; 12:cancers12113094. [PMID: 33114141 PMCID: PMC7690788 DOI: 10.3390/cancers12113094] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/07/2020] [Accepted: 10/19/2020] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Osteoporosis is a prevalent condition affecting 200 million individuals world-wide. Estimates are about one in three women will experience a fragility fracture of hip, spine or wrist. Common breast cancer treatments, such as aromatase inhibitors in postmenopausal women and chemotherapy-induced ovarian failure in premenopausal women, cause bone loss that in some women will lead to osteoporosis and fragility fractures. Fragility fractures cause morbidity and mortality and are entirely preventable. Prevention or treatment of osteoporosis includes lifestyle modifications (e.g., reducing smoking and excessive alcohol consumption, and increasing physical activity), taking calcium and vitamin D3, screening for osteoporosis with dual-energy absorptiometry, and treatment, if clinically indicated, with ether oral bisphosphonates, intravenous zoledronic acid, or subcutaneous denosumab. This chapter reviews the pathogenesis of osteoporosis, the magnitude of bone loss related to common breast cancer treatments, osteoporosis risk factor assessment and screening, and the specific drugs to treat or prevent osteoporosis. Abstract Osteoporosis is both a long-term effect (occurs during treatment and extends after treatment) and a late-effect (occurs after treatment ends) of breast cancer treatments. The worldwide prevalence of osteoporosis is estimated to be some 200 million patients. About one in three postmenopausal women will experience an osteoporotic (or fragility) fracture of the hip, spine, or wrist. breast cancer treatments, including gonadotropin-releasing hormone (GnRH) agonists, chemotherapy-induced ovarian failure (CIOF), and aromatase inhibitors (AIs), cause bone loss and increase the risks of osteoporosis. Also, breast cancer is a disease of aging, and most of the “one in eight” lifetime risks of breast cancer are in women in their sixth, seventh, and eighth decades. The majority of women diagnosed with breast cancers today will be long-term survivors and experience personal cures. It is the coalescence of osteoporosis with breast cancer, two common and age-related conditions that make osteoporosis relevant in women with breast cancer throughout the continuum from diagnosis, treatment, and survivorship. It is critical to remember that women (and men) will lose bone after age thirty years. However, only certain women will lose bone of sufficient magnitude to merit treatment with anti-osteoporosis drugs. The narrative review is intended for medical, surgical, radiation oncologists, and other mid-level providers, and provides an overview of bone loss and the prevention and treatment of osteoporosis.
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Abstract
The screening, prevention and treatment of osteoporosis are similar in women with or without breast cancer. Breast cancer treatments, such as aromatase inhibitors, chemotherapy-induced ovarian failure and gonadotropin-releasing hormone antagonists all decrease estrogen levels, which in turn causes net bone resorption and bone loss. Bone loss over time will be of sufficient magnitude to cause some women to experience fractures. Thus, osteoporosis is an equation; the peak bone mass achieved by age 30 years minus the age-related and menopausal bone loss. Women should have their bone density measured by dual x-ray absorptiometry scans every 2 years. As clinically indicated, women should receive anti-osteoporosis drugs such as zoledronic acid, denosumab or oral bisphosphonates.
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Affiliation(s)
- Charles L Shapiro
- Division of Hematology/Oncology, Icahn School of Medicine at Mt Sinai New York, NY 10029, USA
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Sella T, Partridge AH. Fertility Counseling and Preservation in Breast Cancer. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-019-00348-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Edib Z, Jayasinghe Y, Hickey M, Stafford L, Anderson RA, Su HI, Stern K, Saunders C, Anazodo A, Macheras-Magias M, Chang S, Pang P, Agresta F, Chin-Lenn L, Cui W, Pratt S, Gorelik A, Peate M. Exploring the facilitators and barriers to using an online infertility risk prediction tool (FoRECAsT) for young women with breast cancer: a qualitative study protocol. BMJ Open 2020; 10:e033669. [PMID: 32047016 PMCID: PMC7044829 DOI: 10.1136/bmjopen-2019-033669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION As cancer treatments may impact on fertility, a high priority for young patients with breast cancer is access to evidence-based, personalised information for them and their healthcare providers to guide treatment and fertility-related decisions prior to cancer treatment. Current tools to predict fertility outcomes after breast cancer treatments are imprecise and do not offer individualised prediction. To address the gap, we are developing a novel personalised infertility risk prediction tool (FoRECAsT) for premenopausal patients with breast cancer that considers current reproductive status, planned chemotherapy and adjuvant endocrine therapy to determine likely post-treatment infertility. The aim of this study is to explore the feasibility of implementing this FoRECAsT tool into clinical practice by exploring the barriers and facilitators of its use among patients and healthcare providers. METHODS AND ANALYSIS A cross-sectional exploratory study is being conducted using semistructured in-depth telephone interviews with 15-20 participants each from the following groups: (1) premenopausal patients with breast cancer younger than 40, diagnosed within last 5 years, (2) breast surgeons, (3) breast medical oncologists, (4) breast care nurses (5) fertility specialists and (6) fertility preservation nurses. Patients with breast cancer are being recruited from the joint Breast Service of three affiliated institutions of Victorian Comprehensive Cancer Centre in Melbourne, Australia-Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Royal Women's Hospital, and clinicians are being recruited from across Australia. Interviews are being audio recorded, transcribed verbatim and imported into qualitative data analysis software to facilitate data management and analyses. ETHICS AND DISSEMINATION The study protocol has been approved by Melbourne Health Human Research Ethics Committee, Australia (HREC number: 2017.163). Confidentiality and privacy are maintained at every stage of the study. Findings will be disseminated through peer-reviewed scholarly and scientific journals, national and international conference presentations, social media, broadcast media, print media, internet and various community/stakeholder engagement activities.
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Affiliation(s)
- Zobaida Edib
- Obstetrics & Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
- Obstetrics & Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Yasmin Jayasinghe
- Obstetrics & Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
- Obstetrics & Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Martha Hickey
- Obstetrics & Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
- Obstetrics & Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Lesley Stafford
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Women's Mental Health, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Richard A Anderson
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, Edinburgh, UK
| | - H Irene Su
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California, USA
| | - Kate Stern
- Melbourne IVF, East Melbourne, Victoria, Australia
- Reproductive Services, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Christobel Saunders
- School of Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - Antoinette Anazodo
- Sydney Children's Hospital, School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Children's Hospital, Randwick, New South Wales, Australia
| | | | - Shanton Chang
- School of Computing and Information Systems, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick Pang
- School of Computing and Information Systems, The University of Melbourne, Melbourne, Victoria, Australia
| | - Franca Agresta
- Melbourne IVF, East Melbourne, Victoria, Australia
- Reproductive Services, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Laura Chin-Lenn
- Department of General Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Wanyuan Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sarah Pratt
- Breast Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alex Gorelik
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Michelle Peate
- Obstetrics & Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
- Obstetrics & Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
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Shapiro CL, Van Poznak C, Lacchetti C, Kirshner J, Eastell R, Gagel R, Smith S, Edwards BJ, Frank E, Lyman GH, Smith MR, Mhaskar R, Henderson T, Neuner J. Management of Osteoporosis in Survivors of Adult Cancers With Nonmetastatic Disease: ASCO Clinical Practice Guideline. J Clin Oncol 2019; 37:2916-2946. [DOI: 10.1200/jco.19.01696] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The aim of this work is to provide evidence-based guidance on the management of osteoporosis in survivors of adult cancer. METHODS ASCO convened a multidisciplinary Expert Panel to develop guideline recommendations based on a systematic review of the literature. RESULTS The literature search of the 2018 systematic review by the US Preventive Services Task Force in the noncancer population was used as the evidentiary base upon which the Expert Panel based many of its recommendations. A total of 61 additional studies on topics and populations not covered in the US Preventive Services Task Force review were also included. Patients with cancer with metastatic disease and cancer survival outcomes related to bone-modifying agents are not included in this guideline. RECOMMENDATIONS Patients with nonmetastatic cancer may be at risk for osteoporotic fractures due to baseline risks or due to the added risks that are associated with their cancer therapy. Clinicians are advised to assess fracture risk using established tools. For those patients with substantial risk of osteoporotic fracture, the clinician should obtain a bone mineral density test. The bone health of all patients may benefit from optimizing nutrition, exercise, and lifestyle. When a pharmacologic agent is indicated, bisphosphonates or denosumab at osteoporosis-indicated dosages are the preferred interventions.
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Affiliation(s)
| | | | | | - Jeffrey Kirshner
- Hematology-Oncology Associates of Central New York, Syracuse, NY
| | | | | | | | - Beatrice J. Edwards
- University of Texas Dell Med School and Central Texas Veterans Healthcare System, Austin, TX
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Blumenfeld Z. Fertility Preservation Using GnRH Agonists: Rationale, Possible Mechanisms, and Explanation of Controversy. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2019; 13:1179558119870163. [PMID: 31488958 PMCID: PMC6710670 DOI: 10.1177/1179558119870163] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 12/15/2022]
Abstract
The only clinically accepted method of fertility preservation in young women facing gonadotoxic chemo- and/or radiotherapy for malignant or autoimmune diseases is cryopreservation of embryos or unfertilized ova, whereas cryopreservation of ovarian tissue for future reimplantation, or in vitro maturation of follicles, and the use of gonadotropin-releasing hormone agonists (GnRHa) are still considered investigational, by several authorities. Whereas previous publications have raised the fear of GnRHa's possible detrimental effects in patients with hormone receptor-positive breast cancers, recent randomized controlled trials (RCTs) have shown that it either improves or does not affect disease-free survival (DFS) in such patients. This review summarizes the pros and cons of GnRHa co-treatment for fertility preservation, suggesting 5 theoretical mechanisms for GnRHa action: (1) simulating the prepubertal hypogonadotropic milieu, (2) direct effect on GnRH receptors, (3) decreased ovarian perfusion, (4) upregulation of an ovarian-protecting molecule such as sphingosine-1-phosphate, and (5) protecting a possible germinative stem cell. We try to explain the reasons for the discrepancy between most publications that support the use of GnRHa for fertility preservation and the minority of publications that did not support its efficiency.
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Affiliation(s)
- Zeev Blumenfeld
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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17
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Leysen L, Lahousse A, Nijs J, Adriaenssens N, Mairesse O, Ivakhnov S, Bilterys T, Van Looveren E, Pas R, Beckwée D. Prevalence and risk factors of sleep disturbances in breast cancersurvivors: systematic review and meta-analyses. Support Care Cancer 2019; 27:4401-4433. [DOI: 10.1007/s00520-019-04936-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 06/11/2019] [Indexed: 01/31/2023]
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18
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Zhong Y, Lin Y, Cheng X, Huang X, Zhou Y, Mao F, Wang Y, Guan J, Shen S, Xu Y, Peng L, Li Y, Cao X, Sun Q. GnRHa for Ovarian Protection and the Association between AMH and Ovarian Function during Adjuvant Chemotherapy for Breast Cancer. J Cancer 2019; 10:4278-4285. [PMID: 31413747 PMCID: PMC6691711 DOI: 10.7150/jca.31859] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/19/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Chemotherapy impairs ovarian function in premenopausal breast cancer patients. Many breast cancer patients experience menopause earlier and therefore lose their reproductive abilities. The protective effect of gonadotropin-releasing hormone agonist (GnRha) upon the ovary is clearly apparent for hormone receptor (HR) negative patients, although the available data is not consistent for the patient body as a whole when considered regardless of HR status. It is also unknown whether levels of Anti-Mullerian Hormone (AMH) can reflect the influence of chemotherapy upon the ovary. Methods: We randomly assigned 98 premenopausal breast cancer patients regardless HR-positive or -negative to receive either standard chemotherapy with GnRHa (GnRHa group) or standard chemotherapy without GnRHa (control group). Our primary end point was ovarian failure rate (OVF) at 1 year. In addition, we observed the change of AMH level during chemotherapy and the association between AMH and OVF. Results: OVF was significantly lower (44.7%) in the GnRHa group than in the control group (80.6%; P=0.002). Median AMH levels were significantly higher before chemotherapy when compared to after 1/2cycles of chemotherapy, both in the GnRHa group (1.86ng/ml vs 0.12ng/ml; P=0.000) and in the control group (1.57ng/ml vs 0.10ng/ml; P=0.000). OVF was 91.3% in the AMH baseline level <1.1ng/ml group and 63.5% in the AMH baseline level >1.1ng/ml group (P=0.013). Conclusion: Data showed that GnRHa may have a protective effect on young breast cancer patients regardless of HR during chemotherapy. AMH could reflect changes of OVF during chemotherapy and predict OVF after chemotherapy.
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Affiliation(s)
- Ying Zhong
- Department of Breast Disease, Peking Union Medical College Hospital, Shuaifuyuan, Wangfujing, Beijing 100730, China
| | - Yan Lin
- Department of Breast Disease, Peking Union Medical College Hospital, Shuaifuyuan, Wangfujing, Beijing 100730, China
| | - Xinqi Cheng
- Department of Clinical laboratory, Peking Union Medical College Hospital, Shuaifuyuan, Wangfujing, Beijing 100730, China
| | - Xin Huang
- Department of Breast Disease, Peking Union Medical College Hospital, Shuaifuyuan, Wangfujing, Beijing 100730, China
| | - Yidong Zhou
- Department of Breast Disease, Peking Union Medical College Hospital, Shuaifuyuan, Wangfujing, Beijing 100730, China
| | - Feng Mao
- Department of Breast Disease, Peking Union Medical College Hospital, Shuaifuyuan, Wangfujing, Beijing 100730, China
| | - Yajing Wang
- Department of Clinical laboratory, Peking Union Medical College Hospital, Shuaifuyuan, Wangfujing, Beijing 100730, China
| | - Jinghong Guan
- Department of Breast Disease, Peking Union Medical College Hospital, Shuaifuyuan, Wangfujing, Beijing 100730, China
| | - Songjie Shen
- Department of Breast Disease, Peking Union Medical College Hospital, Shuaifuyuan, Wangfujing, Beijing 100730, China
| | - Yali Xu
- Department of Breast Disease, Peking Union Medical College Hospital, Shuaifuyuan, Wangfujing, Beijing 100730, China
| | - Li Peng
- Department of Breast Disease, Peking Union Medical College Hospital, Shuaifuyuan, Wangfujing, Beijing 100730, China
| | - Yan Li
- Department of Breast Disease, Peking Union Medical College Hospital, Shuaifuyuan, Wangfujing, Beijing 100730, China
| | - Xi Cao
- Department of Breast Disease, Peking Union Medical College Hospital, Shuaifuyuan, Wangfujing, Beijing 100730, China
| | - Qiang Sun
- Department of Breast Disease, Peking Union Medical College Hospital, Shuaifuyuan, Wangfujing, Beijing 100730, China
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Faruqi F, Cathcart-Rake E, Ruddy KJ. We need to educate young lung cancer patients about menopause risk. Lung Cancer Manag 2019; 8:LMT08. [PMID: 31044017 PMCID: PMC6488940 DOI: 10.2217/lmt-2018-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/17/2018] [Indexed: 11/21/2022] Open
Affiliation(s)
- Fahad Faruqi
- Mayo Clinic, Department of Medical Oncology, 200 First Street, SW, Rochester, MN 55901, USA
| | | | - Kathryn J Ruddy
- Mayo Clinic, Department of Medical Oncology, 200 First Street, SW, Rochester, MN 55901, USA
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Gompel A, Ramirez I, Bitzer J. Contraception in cancer survivors - an expert review Part I. Breast and gynaecological cancers. EUR J CONTRACEP REPR 2019; 24:167-174. [PMID: 31033361 DOI: 10.1080/13625187.2019.1602721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: The efficacy of treatment for many cancers has increased dramatically in recent decades and there are a growing number of cancer survivors who need effective contraception. In this paper, a group of experts from the European Society of Contraception set out to define the most frequent cancers in women and summarise the guidelines, reviews and studies that provide information and guidance on contraception for each cancer. Methods: Epidemiological studies were analysed to determine the frequency of cancers in women of reproductive age. A narrative review was performed for each cancer, collecting data about the treatment of the disease, its impact on fertility, and the efficacy, health risks, possible benefits and contraindications of the contraceptive methods available. The recommendations were then summarised. Results: Owing to a large amount of information, the results are presented in two parts. Part 1 includes contraception after breast and gynaecological cancers. Part 2 summarises the findings and recommendations regarding contraception in women with skin, gastrointestinal, haematological and endocrine cancers.
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Affiliation(s)
- Anne Gompel
- a Department of Gynaecology, Faculty of Medicine , Paris Descartes University , Paris , France
| | - Isabel Ramirez
- b Sexual and Reproductive Health Service , UGC Dr Cayetano Roldan San Fernando Health Centre , Cadiz , Spain
| | - Johannes Bitzer
- c Department of Obstetrics and Gynaecology , Basel University Hospital , Basel , Switzerland
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Lee HM, Kim BW, Park S, Park S, Lee JE, Choi YJ, Kim SY, Woo SU, Youn HJ, Lee I. Childbirth in young Korean women with previously treated breast cancer: The SMARTSHIP study. Breast Cancer Res Treat 2019; 176:419-427. [DOI: 10.1007/s10549-019-05244-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/15/2019] [Indexed: 12/13/2022]
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22
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The frequency and predictors of persistent amenorrhea in premenopausal women with colorectal cancer who received adjuvant chemotherapy. Anticancer Drugs 2019; 30:289-294. [PMID: 30640791 DOI: 10.1097/cad.0000000000000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to identify the frequency of chemotherapy-induced amenorrhea and associated factors thereof in premenopausal female patients diagnosed with colon cancer. Premenopausal female patients under the age of 50 years who were diagnosed with stages I, II, and III colon cancer were included. A questionnaire surveying personal history including menarche, comorbidities, drugs, other clinical features, and menstrual history during and after completion of chemotherapy was filled by the patients during outpatient visits. Patients who received pelvic radiotherapy were excluded from the study. A total of 60 patients were included in the study. Eleven patients had been treated with surgery alone, and 49 patients had received adjuvant chemotherapy with either fluorouracil (5-FU) alone (n=22) or 5-FU+oxaliplatin (n=27). The frequency of persistent amenorrhea 1 year after receiving chemotherapy was 20% in the whole group, 18% in patients who had received adjuvant chemotherapy with 5-FU alone, and 22% in patients who had received chemotherapy with 5-FU+oxaliplatin. Frequency of persistent amenorrhea was 3.5% in patients under the age of 44 years and 42.8% in patients aged 44 years and older. Multivariate analysis showed that age of 44 years and older (hazard ratio: 29.3; 95% confidence interval: 2.8-309.2, P=0.005) and menarche age of 14 years and older (hazard ratio: 7.6; 95% confidence interval: 1.2-49, P=0.076) were significantly associated with increased risk of persistent amenorrhea. In this study, we found that the frequency of persistent amenorrhea was 20% in patients who received 5-FU monotherapy or oxaliplatin-based adjuvant chemotherapy protocols in colon cancer treatment. Older age and later menarche were the factors that increased the risk of persistent amenorrhea 1 year after chemotherapy.
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Bao T, Peppone LJ, Robinson P. Addressing the Unintentional Consequences of Cancer Therapy With Novel Integrative Therapeutics. Am Soc Clin Oncol Educ Book 2018; 38:822-828. [PMID: 30231327 DOI: 10.1200/edbk_201411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There are 15.5 million cancer survivors in the United States because of, in part, improvements in therapy. As a result, there will be an increased burden of long- and late-term complications of cancer care, such as metabolic alterations. These metabolic changes will include alterations in bone resorption, obesity, hypercholesterolemia, and diabetes mellitus. The majority of cancer treatment-related toxicities have focused on endocrine therapy; however, chemotherapy and supportive medications, such as steroids, contribute to the development of these disorders. Because of the chronicity of these metabolic changes and their impact on morbidity, cancer risk, and outcomes as well other negative effects, including musculoskeletal pain and vasomotor symptoms, alternative strategies must be developed. These strategies should include nonpharmacologic approaches. Here, we summarize metabolic changes secondary to cancer care and integrative approaches to help alleviate therapy-associated toxicities.
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Affiliation(s)
- Ting Bao
- From the Memorial Sloan Kettering Cancer Center, New York, NY; University of Rochester Medical Center, Rochester, NY; Loyola University Medical Center, Maywood, IL
| | - Luke J Peppone
- From the Memorial Sloan Kettering Cancer Center, New York, NY; University of Rochester Medical Center, Rochester, NY; Loyola University Medical Center, Maywood, IL
| | - Patricia Robinson
- From the Memorial Sloan Kettering Cancer Center, New York, NY; University of Rochester Medical Center, Rochester, NY; Loyola University Medical Center, Maywood, IL
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Leonard RCF, Adamson DJA, Bertelli G, Mansi J, Yellowlees A, Dunlop J, Thomas GA, Coleman RE, Anderson RA. GnRH agonist for protection against ovarian toxicity during chemotherapy for early breast cancer: the Anglo Celtic Group OPTION trial. Ann Oncol 2018; 28:1811-1816. [PMID: 28472240 DOI: 10.1093/annonc/mdx184] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Chemotherapy-induced premature ovarian insufficiency (POI) impacts fertility and other aspects of women's health. The OPTION trial tested whether administration of a gonadotropin-releasing hormone agonist during chemotherapy for early breast cancer reduced the risk of POI. Patients and methods This was a prospective, randomized, parallel group study of the gonadotropin-releasing hormone agonist goserelin administered before and during chemotherapy for breast cancer with stage I-IIIB disease. The primary outcome was amenorrhoea between 12 and 24 months after randomization, supported by elevated follicle stimulating hormone concentrations to give an additional analysis as rate of POI. Results A total of 227 patients were randomized and the primary analysis was conducted on 202 patients. Goserelin reduced the prevalence of amenorrhoea between 12 and 24 months to 22% versus 38% in the control group (P = 0.015) and the prevalence of POI to 18.5% versus 34.8% in the control group (P = 0.048). Follicle stimulating hormone concentrations were also lower in all women treated with goserelin at both 12 and 24 months (P = 0.027, P = 0.001, respectively). The effect of goserelin was not statistically significant in women >40 years. Assessment of the ovarian reserve using anti-Müllerian hormone showed a marked fall in both groups during treatment to median values of 5% of pretreatment levels in the control group and 7% in the goserelin group, which were not significantly different between groups. Conclusion This study shows that goserelin reduced the risk of POI in women treated with chemotherapy for early breast cancer, with particular efficacy in women aged ≤40 years old. The degree of ovarian protection also seems limited and the clinical significance for fertility and longer term prevention of estrogen deficiency-related outcomes needs to be determined.
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Affiliation(s)
- R C F Leonard
- Department of Surgery and Oncology, Imperial College, London
| | | | - G Bertelli
- Department of Oncology, Singleton Hospital, Swansea
| | - J Mansi
- Department of Oncology, NHS Foundation Trust, Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College, London
| | | | - J Dunlop
- Scottish Clinical Trials Research Unit, Information Services Division, NHS National Services Scotland, Edinburgh
| | - G A Thomas
- Department of Surgery and Oncology, Imperial College, London
| | - R E Coleman
- Department of Oncology, Sheffield University, Sheffield
| | - R A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
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25
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Gorman JR, Julian AK, Roberts SA, Romero SAD, Ehren JL, Krychman ML, Boles SG, Mao J, Irene Su H. Developing a post-treatment survivorship care plan to help breast cancer survivors understand their fertility. Support Care Cancer 2017; 26:589-595. [PMID: 28913697 DOI: 10.1007/s00520-017-3871-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/04/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Reproductive-aged breast cancer survivors (BCS) who have completed initial cancer treatment frequently want to know about their future fertility potential. The purpose of this qualitative study was to assess if the fertility-related content presented in the survivorship care plan prototype met the informational needs of post-treatment BCS and to provide an opportunity for the target audience to review and react to the proposed content and design. METHODS We conducted and analyzed transcripts from seven focus groups with BCS to evaluate their reactions to the survivorship care plan prototype. We independently coded transcripts for consistent themes and sub-themes and used a consensus-building approach to agree on interpretation of results. RESULTS We identified five themes that describe the post-treatment BCS' responses to the prototype survivorship care plan in the context of their informational needs and experiences: (1) the prototype's fertility-related information is relevant; (2) desire for clinical parameters to help survivors understand their infertility risk; (3) fertility-related information is important throughout survivorship; (4) evidence-based content from a neutral source is trustworthy; and (5) the recommendation to see a fertility specialist is helpful, but cost is a barrier. CONCLUSIONS BCS have concerns and needs related to their fertility potential after initial breast cancer treatment. The evidence-based information offered in our prototype survivorship care plan was acceptable to BCS and has significant potential to address these needs. Additional primary data that identify post-cancer treatment indicators of fertility would advance this effort.
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Affiliation(s)
- Jessica R Gorman
- School of Social and Behavioral Health Sciences, Oregon State University College of Public Health and Human Sciences, Corvallis, OR, 97331, USA.
| | - Anne K Julian
- School of Social and Behavioral Health Sciences, Oregon State University College of Public Health and Human Sciences, Corvallis, OR, 97331, USA
| | - Samantha A Roberts
- Moores Cancer Center, University of California San Diego, La Jolla, CA, 92093, USA
| | - Sally A D Romero
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | | | - Michael L Krychman
- Southern California Center for Sexual Health and Survivorship Medicine, Newport Beach, CA, 92663, USA.,Department of Obstetrics and Gynecology, University of California, Irvine, CA, 92697, USA
| | - Sarah G Boles
- Moores Cancer Center, University of California San Diego, La Jolla, CA, 92093, USA
| | - Jun Mao
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - H Irene Su
- Moores Cancer Center, University of California San Diego, La Jolla, CA, 92093, USA
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Letourneau JM, Sinha N, Wald K, Harris E, Quinn M, Imbar T, Mok-Lin E, Chien AJ, Rosen M. Random start ovarian stimulation for fertility preservation appears unlikely to delay initiation of neoadjuvant chemotherapy for breast cancer. Hum Reprod 2017; 32:2123-2129. [DOI: 10.1093/humrep/dex276] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/02/2017] [Indexed: 01/25/2023] Open
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Park I, Lee S, Ryu KJ, Min KJ, Hong JH, Song JY, Lee JK, Lee NW. A gonadotropin-releasing hormone agonist for the prevention of docetaxel-induced gonadal damage. J OBSTET GYNAECOL 2017; 37:783-789. [DOI: 10.1080/01443615.2017.1306839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ilhae Park
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sanghoon Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ki-Jin Ryu
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Jin Min
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jin Hwa Hong
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Yun Song
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Kwan Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Nak Woo Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
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Azim HA, Davidson NE, Ruddy KJ. Challenges in Treating Premenopausal Women with Endocrine-Sensitive Breast Cancer. Am Soc Clin Oncol Educ Book 2017; 35:23-32. [PMID: 27249683 DOI: 10.1200/edbk_159069] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
For the hundreds of thousands of premenopausal women who are diagnosed annually with endocrine-sensitive breast cancer, treatment strategies are complex. For many, chemotherapy may not be necessary, and endocrine therapy decision making is paramount. Options for adjuvant endocrine regimens include tamoxifen for 5 years, tamoxifen for 10 years, ovarian function suppression (OFS) plus tamoxifen for 5 years, and OFS plus an aromatase inhibitor for 5 years. There are modest differences in efficacy between these regimens, with a benefit from OFS most obvious among patients with higher-risk disease; therefore, choosing which should be used for a given patient requires consideration of expected toxicities and patient preferences. An aromatase inhibitor cannot be safely prescribed without OFS in this setting. Additional research is needed to determine whether genomic tests such as Prosigna and Endopredict can help with decision making about optimal duration of endocrine therapy for premenopausal patients. Endocrine therapy side effects can include hot flashes, sexual dysfunction, osteoporosis, and infertility, all of which may impair quality of life and can encourage nonadherence with treatment. Ovarian function suppression worsens menopausal side effects. Hot flashes tend to be worse with tamoxifen/OFS, whereas sexual dysfunction and osteoporosis tend to be worse with aromatase inhibitors/OFS. Pregnancy is safe after endocrine therapy, and some survivors can conceive naturally. Still, embryo or oocyte cryopreservation should be considered at the time of diagnosis for patients with endocrine-sensitive disease who desire future childbearing, particularly if they will undergo chemotherapy.
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Affiliation(s)
- Hatem A Azim
- From the Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Pittsburgh Cancer Institute and UPMC Cancer Center, Pittsburgh, PA; Department of Oncology, Mayo Clinic, Rochester, MN
| | - Nancy E Davidson
- From the Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Pittsburgh Cancer Institute and UPMC Cancer Center, Pittsburgh, PA; Department of Oncology, Mayo Clinic, Rochester, MN
| | - Kathryn J Ruddy
- From the Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Pittsburgh Cancer Institute and UPMC Cancer Center, Pittsburgh, PA; Department of Oncology, Mayo Clinic, Rochester, MN
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29
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Lambertini M, Azim HA, Peccatori FA. Fertility Issues in Patients with Breast Cancer or Survivors. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Wolff AC, Rugo HS. Still Refining Adjuvant Endocrine Therapy in Premenopausal Women: Not Too Much, Not Too Little. J Clin Oncol 2016; 34:2203-5. [PMID: 27185850 DOI: 10.1200/jco.2016.67.0463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Antonio C Wolff
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Hope S Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
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31
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Scharl A, Salterberg A, Untch M, Liedtke C, Stickeler E, Papathemelis T. Treatment Modification in Young Breast Cancer Patients. Oncol Res Treat 2016; 39:122-8. [PMID: 27031253 DOI: 10.1159/000444355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 01/29/2016] [Indexed: 11/19/2022]
Abstract
Patients not older than 40 years are referred to as young patients. These women benefit from chemo-, endocrine and anti-HER2 therapy to a similar degree as older women. Surgery and radiation therapy also follow the same recommendations. This manuscript deals with the following topics that need special consideration in young women: endocrine therapy and ovarian suppression; fertility protection and family planning; and genetic counselling. There is an on-going debate on whether tamoxifen is sufficient as an endocrine treatment in young patients with endocrine-responsive tumours or whether suppression of ovarian function in combination with tamoxifen or aromatase inhibitor should be preferred. Recent data suggest a benefit from ovarian suppression plus exemestane in women of 35 years or younger with high-risk breast cancer. However, increased side effects bear the risk of lesser compliance, which eventually results in higher mortality. Child bearing is nowadays frequently postponed to the 4th decade of life, thereby increasing the number of women who have not yet finished their reproductive desires when diagnosed with breast cancer. These patients are in urgent need of counselling for fertility protection. Breast cancer diagnosis at young age is an indication for a possible mutation in breast cancer susceptibility genes. This has an impact on the cancer risk of the whole family, especially the offspring. Drugs that are specifically targeted to cancer cells with genetic alterations that impair DNA repair are already entering the arsenal of oncologists.
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Affiliation(s)
- Anton Scharl
- Frauenklinik, Klinikum St. Marien Amberg, Amberg, Germany
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Jacobson MH, Mertens AC, Spencer JB, Manatunga AK, Howards PP. Menses resumption after cancer treatment-induced amenorrhea occurs early or not at all. Fertil Steril 2015; 105:765-772.e4. [PMID: 26658130 DOI: 10.1016/j.fertnstert.2015.11.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/28/2015] [Accepted: 11/09/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify factors associated with cancer treatment-induced amenorrhea and time to return of menses. DESIGN Population-based cohort study. SETTING Not applicable. PATIENT(S) Female cancer survivors who were diagnosed with cancer between the ages of 20 and 35 and were at least 2 years postdiagnosis at the time of recruitment (median = 7 years; interquartile range, 5-11). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Amenorrhea (≥6 months without menses) and resumption of menses. RESULT(S) After excluding women with hysterectomies before cancer diagnosis, 1,043 women were eligible for analysis. Amenorrhea occurred in 31.6% of women. Among women treated with chemotherapy (n = 596), older age at diagnosis (30-35 vs. 20-24 years: adjusted odds ratio [aOR] = 2.37; 95% confidence interval [CI], 1.30, 4.30) and nulligravidity (vs. gravid: aOR = 1.50; 95% CI, 1.02, 2.21) were risk factors for amenorrhea. Among amenorrheic women, menses resumed in most (70.0%), and resumption occurred within 2 years of treatment for 90.0% of women. Survivors of breast cancer were more likely to resume menses at times greater than 1 year compared with lymphoma and pelvic-area cancers. Women diagnosed at older ages, those exposed to chemotherapy, and those exposed to any radiation experienced longer times to return of menses. Women who were older at diagnosis were more likely to have irregular cycles when menses returned. CONCLUSION(S) Treatment-induced amenorrhea is common in cancer survivors, although most women resume menses within 2 years. However, once resumed, older women are more likely to have irregular cycles. Age at diagnosis and pregnancy history affect the risk of amenorrhea.
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Affiliation(s)
- Melanie H Jacobson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
| | - Ann C Mertens
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica B Spencer
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Amita K Manatunga
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Tao JJ, Visvanathan K, Wolff AC. Long term side effects of adjuvant chemotherapy in patients with early breast cancer. Breast 2015; 24 Suppl 2:S149-53. [PMID: 26299406 DOI: 10.1016/j.breast.2015.07.035] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Adjuvant systemic therapy along with screening has been key to the observed improvements in disease-free and overall survival (DFS/OS) in breast cancer. Improvements in overall survival already take into account therapy related toxicities that can result in death. However, this measure alone does not adequately capture the impact on health-related quality of life. Therefore, it is important to examine the prevalence, frequency and short/long-term impact of therapy-related toxicities, identify patients who might be at greatest risk. Ultimately decisions regarding expected therapy benefits (relative and absolute percentage improvements in DFS/OS) must be made against a background of known potential harms. For many patients with early breast cancer (EBC), their risk of recurrence is not zero but is small. At the same time, for many therapies for early stage breast cancer, the risk of serious side effects is small but is not zero. As we better understand the long-term side effects of adjuvant chemotherapy and targeted therapy, it becomes critical to integrate our growing understanding of breast cancer biology with standard high-quality histopathologic measures to better identify the patients most likely to benefit from the various options for combined multimodality therapy. Hence, we must strive against the notion of recommending adjuvant systemic chemotherapy "just in case." This article focuses on the long-term side effects of adjuvant chemotherapy in patients with EBC.
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Affiliation(s)
- Jessica J Tao
- Johns Hopkins University School of Medicine, Bloomberg School of Public Health, and Sidney Kimmel Comprehensive Cancer Center, 1650 Orleans Street, CRB1-189, Baltimore, MD 21287, USA
| | - Kala Visvanathan
- Johns Hopkins University School of Medicine, Bloomberg School of Public Health, and Sidney Kimmel Comprehensive Cancer Center, 1650 Orleans Street, CRB1-189, Baltimore, MD 21287, USA
| | - Antonio C Wolff
- Johns Hopkins University School of Medicine, Bloomberg School of Public Health, and Sidney Kimmel Comprehensive Cancer Center, 1650 Orleans Street, CRB1-189, Baltimore, MD 21287, USA.
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Roberts J, Ronn R, Tallon N, Holzer H. Fertility preservation in reproductive-age women facing gonadotoxic treatments. Curr Oncol 2015; 22:e294-304. [PMID: 26300680 PMCID: PMC4530827 DOI: 10.3747/co.22.2334] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Advancements in the treatments for cancer and autoimmune and other hematologic conditions continue to improve survival and cure rates. Despite those changes, various gonadotoxic agents and other treatments can still compromise the future fertility of many women. Progress in medical and surgical reproductive technologies has helped to offset the reproductive consequences of the use of gonadotoxic therapies, and allows for future fertility and normal pregnancy. METHODS A review of the literature was performed to outline the pathophysiology of gonadotoxicity from various treatments. The success of fertility preservation, fertility sparing, and cryopreservation options are reviewed. Barriers and facilitators to referral and oncofertility treatment in Canada are also outlined. RESULTS According to the quality of the evidence, recommendations are made for fertility assessment, patient referral, cryopreservation, and other assisted reproductive technologies. CONCLUSIONS To ensure ongoing fertility in women undergoing gonadotoxic treatments, assisted reproductive technologies can be combined with a multidisciplinary approach to patient assessment and referral.
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Affiliation(s)
- J. Roberts
- Pacific Centre for Reproductive Medicine, Burnaby, BC
| | - R. Ronn
- Department of Obstetrics and Gynecology, Queen’s University, Kingston, ON
| | - N. Tallon
- Pacific Centre for Reproductive Medicine, Burnaby, BC
| | - H. Holzer
- McGill University Health Centre, Reproductive Centre, and Department of Obstetrics and Gynecology, McGill University, Montreal, QC
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Meissner J, Tichy D, Katzke V, Kühn T, Dietrich S, Schmitt T, Ziepert M, Kuhnt E, Rixecker T, Zorn M, Witzens-Harig M, Pfreundschuh M, Ho A. Long-term ovarian function in women treated with CHOP or CHOP plus etoposide for aggressive lymphoma. Ann Oncol 2015; 26:1771-6. [DOI: 10.1093/annonc/mdv227] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/04/2015] [Indexed: 01/01/2023] Open
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36
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El Hachem H, Atallah D, Grynberg M. Fertility preservation in breast cancer patients. Future Oncol 2015; 10:1767-77. [PMID: 25303056 DOI: 10.2217/fon.14.55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Breast cancer is the most common malignant tumor in women of reproductive age, and is characterized by a high survival rate owing to improved antineoplastic treatments. Young survivors face the prospect of a diminished fertility as a consequence of the gonadotoxic chemotherapy, and many are seeking ways to preserve their fertility. Embryo and/or oocyte cryopreservation following controlled ovarian stimulation is currently the fertility preservation method of choice, but breast cancer patients may have contraindications to exogenous gonadotropin administration and may not have enough time to undergo ovarian stimulation prior to chemotherapy. Fortunately, many other options are available for these women, such as the letrozole-follicle-stimulating hormone ovarian stimulation protocol, in vitro maturation of oocytes and ovarian tissue cryopreservation. In this review, we discuss the benefits and disadvantages of the different fertility preservation techniques that can be offered to breast cancer patients.
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Affiliation(s)
- Hady El Hachem
- Service de Gynécologie-Obstétrique, Hôpital Hôtel-Dieu de France, Beyrouth, Liban
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37
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Chemotherapy-related amenorrhea after adjuvant paclitaxel-trastuzumab (APT trial). Breast Cancer Res Treat 2015; 151:589-96. [PMID: 25981899 DOI: 10.1007/s10549-015-3426-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/08/2015] [Indexed: 02/05/2023]
Abstract
Chemotherapy-related amenorrhea (CRA) is associated with infertility and menopausal symptoms. Learning how frequently paclitaxel and trastuzumab cause amenorrhea is important. Most other adjuvant breast cancer therapies induce CRA in approximately 50 % of all premenopausal recipients [1]. 410 patients enrolled on the APT Trial, a single-arm phase 2 adjuvant study of 12 weeks of paclitaxel and trastuzumab followed by nine months of trastuzumab monotherapy. Eligible patients had ≤3 cm node-negative HER2 + breast cancers. Premenopausal enrollees were asked to complete menstrual surveys every 3-12 months for 72 months. Women who responded to at least one survey at least 15 months after chemotherapy initiation (and who did not undergo hysterectomy and/or bilateral oophorectomy or receive ovarian suppressing medications prior to 15 months) were included in this analysis. A participant was defined as having amenorrhea in follow-up if her self-reported last menstrual period at last follow-up was greater than 12 months prior to the survey. Among the 64 women in the evaluable population (median age at study entry 44 years, range 27-52 years), the median time between chemotherapy initiation and last menstrual survey was 51 months (range 16-79). 18 of 64 women (28 %, 95 % CI 18-41 %) were amenorrheic at that time point. Amenorrhea rates among premenopausal women treated with adjuvant paclitaxel and trastuzumab for early stage breast cancer appear lower than those seen historically with standard alkylator-based breast cancer regimens. Future studies are needed to understand the impact of this regimen on related issues of fertility and menopausal symptoms.
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38
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Margulies AL, Selleret L, Zilberman S, Nagarra IT, Chopier J, Gligorov J, Berveiller P, Ballester M, Darai E, Chabbert-Buffet N. [Pregnancy after cancer: for whom and when?]. Bull Cancer 2015; 102:463-9. [PMID: 25917345 DOI: 10.1016/j.bulcan.2015.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/04/2015] [Indexed: 11/18/2022]
Abstract
Planning a pregnancy for patients with a history of cancer, including breast cancer, is a clinical situation that becomes more and more common. Several specific items are to be discussed: decrease of fertility after cancer treatment, fertility preservation options, impact of pregnancy on cancer recurrence risk and appropriate interval between cancer and pregnancy. Programming pregnancy after cancer is doable in a multidisciplinary setting, and begins at cancer diagnosis to anticipate the various specific pitfalls. Favor adequate oncologic care remains the leading rule.
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Affiliation(s)
- Anne Laure Margulies
- AP-HP, hôpital Bichat, département de gynécologie obstétrique médecine de la reproduction, 75018 Paris, France
| | - Lise Selleret
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, département de gynécologie obstétrique médecine de la reproduction, 75020 Paris, France; Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France
| | - Sonia Zilberman
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, département de gynécologie obstétrique médecine de la reproduction, 75020 Paris, France; Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France
| | | | | | - Joseph Gligorov
- Hôpital Tenon, service d'oncologie médicale, 75020 Paris, France
| | - Paul Berveiller
- Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France; AP-HP, hôpital Trousseau, département de gynécologie obstétrique, 75012 Paris, France
| | - Marcos Ballester
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, département de gynécologie obstétrique médecine de la reproduction, 75020 Paris, France; Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, UMRS-938, 75005 Paris, France
| | - Emile Darai
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, département de gynécologie obstétrique médecine de la reproduction, 75020 Paris, France; Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, UMRS-938, 75005 Paris, France
| | - Nathalie Chabbert-Buffet
- AP-HP, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, département de gynécologie obstétrique médecine de la reproduction, 75020 Paris, France; Réseau INCA cancers associés à La grossesse (CALG), 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, UMRS-938, 75005 Paris, France.
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39
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Risk factors for negative impacts on sexual activity and function in younger breast cancer survivors. Psychooncology 2015; 24:1097-103. [DOI: 10.1002/pon.3772] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 01/16/2015] [Accepted: 01/20/2015] [Indexed: 12/21/2022]
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Abstract
Breast cancer is one of the most common malignancies of women in the reproductive years. In the Western world there is a trend towards delaying pregnancy to later in life, and in combination with an increased incidence of breast cancer an increased number of women are diagnosed with breast cancer before they have completed their reproductive plans. In addition, breast cancer during pregnancy may affect an increased number of women as the childbearing years are delayed. The survival rate after breast cancer has improved during the last decades, and many young breast cancer survivors will consider a pregnancy subsequent to the completion of adjuvant breast cancer therapy. Traditionally, many women are advised against a pregnancy due to a fear of increased risk of recurrence, especially women with estrogen receptor-positive breast cancer. Due to feasibility issues, evidence from large prospective randomized trials is missing regarding the safety of pregnancy after breast cancer. Today guidelines are based on cohort studies and population-based registry evidence with its limitations. Overall, data suggest that pregnancy after breast cancer therapy is safe, and the current evidence is summarized in this overview.
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Affiliation(s)
- Charlotta Dabrosin
- a Department of Oncology and Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
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41
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Ovarian reserve in breast cancer: assessment with anti-Müllerian hormone. Reprod Biomed Online 2014; 29:573-80. [DOI: 10.1016/j.rbmo.2014.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 06/19/2014] [Accepted: 07/01/2014] [Indexed: 11/20/2022]
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Blumenfeld Z, Katz G, Evron A. 'An ounce of prevention is worth a pound of cure': the case for and against GnRH-agonist for fertility preservation. Ann Oncol 2014; 25:1719-1728. [PMID: 24651411 DOI: 10.1093/annonc/mdu036] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The late effects of cancer treatment have recently gained a worldwide interest among reproductive endocrinologists, oncologists, and all health-care providers, and the protection against iatrogenic infertility caused by chemotherapy assumes a high priority. Here, we summarize the case for and against using GnRH-agonist for fertility preservation and minimizing chemotherapy-induced gonadotoxicity. The rationale and philosophy supporting its use is that preventing premature ovarian failure (POF) is preferable to treating it, following the dictum: 'an ounce of prevention is worth a pound of cure'. Despite many publications on this subject, there are many equivocal issues necessitating summary. Until now, 20 studies (15 retrospective and 5 randomized, controlled trials) have reported on 1837 patients treated with GnRH-a in parallel to chemotherapy, showing a significant decrease in POF rate in survivors versus 9 studies reporting on 593 patients, with results not supporting GnRH-a use. Patients treated with GnRH-a in parallel to chemotherapy preserved their cyclic ovarian function in 91% of cases when compared with 41% of controls, with a pregnancy rate of 19-71% in the treated patients. Furthermore, seven meta-analyses have concluded that GnRH-a are beneficial and may decrease the risk of POF in survivors. However, controversy still remains regarding the efficiency of GnRH-a in preserving fertility. Since not all the methods involving fertility preservation are unequivocally successful and safe, these young patients deserve to be informed of all the various modalities to minimize gonadal damage and preserve ovarian function and future fertility. Combining several methods for a specific patient may increase the odds for minimally invasive fertility preservation.
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Affiliation(s)
- Z Blumenfeld
- Reproductive Endocrinology, RAMBAM Health Care Campus, The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.
| | - G Katz
- Pinchas Borenstein Talpiot Medical Leadership Program, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel
| | - A Evron
- Reproductive Endocrinology, RAMBAM Health Care Campus, The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
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Sedjo RL, Byers T, Ganz PA, Colditz GA, Demark-Wahnefried W, Wolin KY, Azrad M, Rock CL. Weight gain prior to entry into a weight-loss intervention study among overweight and obese breast cancer survivors. J Cancer Surviv 2014; 8:410-8. [PMID: 24599421 PMCID: PMC4127359 DOI: 10.1007/s11764-014-0351-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/08/2014] [Indexed: 01/03/2023]
Abstract
PURPOSE Changes in cancer therapy, in addition to changes in obesity prevalence, suggest the need for a current assessment of weight gain patterns following breast cancer diagnosis. The aim of this study was to evaluate factors associated with weight gain among breast cancer survivors prior to enrolling into a behavioral weight loss intervention. METHODS Anthropometric measures and data on weight-related factors were collected at baseline on 665 breast cancer survivors. Postdiagnosis weight gain was determined between entry into the trial and previous diagnosis up to 5 years. Multivariate logistic regression analyses were used to evaluate the association between weight gain and influencing factors. RESULTS The mean weight gain was 4.5 % body weight (standard deviation = 10.6); 44 % of women experienced ≥5 % body weight gain. The risk of weight gain was inversely associated with age (adjusted odds ratio (ORadj) = 0.97, 95 % confidence interval (95 % CI) 0.95-0.99), Hispanic ethnicity (ORadj = 0.30, 95 % CI 0.13-0.68), and overweight (ORadj = 0.11, 95 % CI 0.05-0.23) or obese (ORadj = 0.03, 95 % CI 0.02-0.07) status at diagnosis and positively associated with time elapsed since diagnosis (ORadj = 1.19/year, 95 % CI 1.04-1.36). Women prescribed aromatase inhibitors were 46 % less likely to gain weight compared to women prescribed selective estrogen-receptor modulators (ORadj = 0.54, 95 % CI 0.31-0.93). The risk of weight gain was positively associated with smoking at diagnosis (ORadj = 2.69, 95 % CI 1.12-6.49) although this was attributable to women who subsequently quit smoking. CONCLUSIONS Postdiagnosis weight gain is common and complex and influenced by age, ethnicity, weight, smoking status, time elapsed since diagnosis, and endocrine-modulating therapy. IMPLICATIONS FOR CANCER SURVIVORS Weight gain continues to be a concern following a diagnosis of breast cancer. Factors influencing this weight gain include age, ethnicity, weight, smoking status, time elapsed since diagnosis, and endocrine-modulating therapy. Effective weight management strategies are needed for this population of women.
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Affiliation(s)
- Rebecca L Sedjo
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Denver, 13001 East 17th Place, MS F519, Aurora, CO, 80045, USA,
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Chai J, Howie AF, Cameron DA, Anderson RA. A highly-sensitive anti-Müllerian hormone assay improves analysis of ovarian function following chemotherapy for early breast cancer. Eur J Cancer 2014; 50:2367-74. [PMID: 25027307 PMCID: PMC4166459 DOI: 10.1016/j.ejca.2014.06.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 06/11/2014] [Accepted: 06/13/2014] [Indexed: 11/18/2022]
Abstract
Aim Anti-Müllerian hormone (AMH) shows promise as a biomarker of the ovarian reserve but current assays are insufficiently sensitive to allow assessment of this post-chemotherapy in most women. We have assessed a new highly sensitive AMH assay (Ansh picoAMH) in the evaluation of ovarian activity in women with very low ovarian reserve after chemotherapy. Methods A prospective cohort and an independent validation cohort of premenopausal women with early breast cancer (eBC) were recruited at the time of diagnosis (combined n = 98), and ovarian reserve markers 2–5 years later following chemotherapy were assessed in relation to menstrual activity. Results The picoAMH assay had a limit of detection of 7.5 pg/ml. AMH clearly distinguished women with ongoing menses from those with amenorrhoea at 2 years after diagnosis (mean 522 ± 169 versus 8.9 ± 1.3 pg/ml, P < 0.0001) with high predictive value for continuing menses or amenorrhoea for the subsequent 3 years. AMH was detectable in more women than using a previous assay (P = 0.004). Other markers of the ovarian reserve (follicle-stimulating hormone (FSH), inhibin B) were also of discriminatory value but to lesser extents. This finding was validated in a second, independent cohort of women treated for eBC. Conclusion The 10-fold increased assay sensitivity showed very clear distinction between groups based on ovarian activity with excellent prediction of future menses or amenorrhoea. This will improve assessment of post-chemotherapy ovarian function in women and may aid treatment decisions.
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Affiliation(s)
- Joyce Chai
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - A Forbes Howie
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - David A Cameron
- Edinburgh Breast Unit and Edinburgh University Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK.
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Partridge AH. Cancer survivorship and the young breast cancer patient: addressing the important issues. Oncologist 2014; 18:e19-20. [PMID: 23986342 DOI: 10.1634/theoncologist.2013-0300] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ann H Partridge
- Program for Young Women with Breast Cancer, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA.
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46
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Sun X, Dongol S, Jiang J, Kong B. Protection of ovarian function by GnRH agonists during chemotherapy: a meta-analysis. Int J Oncol 2014; 44:1335-40. [PMID: 24535045 DOI: 10.3892/ijo.2014.2296] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 12/23/2013] [Indexed: 11/06/2022] Open
Abstract
This meta-analysis was designed to assess the overall performance of GnRHa in preserving the ovarian function in young women undergoing chemotherapy. Electronic literature databases including Pubmed, MEDLINE, Cochrane library, Embase, CNKI and Wanfang were searched for articles published till November, 2013. The articles written in both Chinese and English were considered. Only randomized controlled trials (RCTs) were selected. Main Outcome Measure was evaluated by assessing the post‑chemotherapy ovarian function. A random-effects model was used to calculate the risk ratio (RR) and associated 95% confidence intervals (95% CI). Out of the eight RCTs including 621 patients, 321 women were treated with GnRHa during chemotherapy, 9.66% of whom suffered premature ovarian failure (POF). On the other hand, 26.67% of the remaining 300 women suffered POF. More women treated without GnRHa experienced post-chemotherapy POF, yielding an RR of 0.45 [chemotherapy plus GnRHa vs. chemotherapy alone, 95% confidence interval (CI) (0.22, 0.92)]. Based on the available studies, GnRHa plays an important role in the prevention of post-chemotherapy POF, but does not exhibit its protective effects in fertility.
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Affiliation(s)
- Xiaomei Sun
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, P.R. China
| | - Samina Dongol
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, P.R. China
| | - Jie Jiang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, P.R. China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, P.R. China
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Gonadotropin-releasing hormone analogues for the prevention of chemotherapy-induced premature ovarian failure in cancer women: systematic review and meta-analysis of randomized trials. Cancer Treat Rev 2013; 40:675-83. [PMID: 24360817 DOI: 10.1016/j.ctrv.2013.12.001] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 11/27/2013] [Accepted: 12/02/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND The role of temporary ovarian suppression with gonadotropin-releasing hormone analogues (GnRHa) in the prevention of chemotherapy-induced premature ovarian failure (POF) is still controversial. We conducted a systematic review and meta-analysis of randomized trials evaluating the efficacy of GnRHa, given before and during chemotherapy, in the prevention of POF in premenopausal cancer patients. METHODS Studies were retrieved by searching PubMed, Web of Knowledge database and the proceedings of major conferences. We calculated Odds Ratios (OR) and 95% confidence intervals (CIs) for POF from each trial and obtained pooled estimates through the random effects model as suggested by DerSimonian and Laird. RESULTS Nine studies were included in the meta-analysis with 225 events of POF occurring in 765 analyzed patients. The pooled OR estimate indicates a highly significant reduction in the risk of POF (OR=0.43; 95% CI: 0.22-0.84; p=0.013) in patients receiving GnRHa. There was statistically significant heterogeneity among studies (I(2)=55.8%; p=0.012). There was no evidence of publication bias. Subgroups analyses showed that the protective effect of GnRHa against POF was similar in subgroups of patients defined by age and timing of POF assessment, while it was present in breast cancer but unclear in ovarian cancer and lymphoma patients. CONCLUSIONS Our pooled analysis of randomized studies shows that the temporary ovarian suppression induced by GnRHa significantly reduces the risk of chemotherapy-induced POF in young cancer patients.
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Abstract
With increasing use of screening mammography and more effective adjuvant systemic therapies, the majority of women diagnosed with early stage breast cancer will be long-term survivors and experience personal cures. Among the common side effects of adjuvant therapies is treatment-related bone loss, primarily as a result of estrogen deprivation. Whereas this occurs in both postmenopausal and premenopausal women, this brief review will focus on pre- or perimenopausal women when initially diagnosed with breast cancer. An important distinction is between those women who retain ovarian function despite cancer or preventative treatments and the more common situation of premenopausal women who as result of cancer treatments undergo ovarian failure or early menopause. Some women with treatment-related ovarian failure will have sufficient treatment-related bone loss to be at increased risks of subsequent nontraumatic fractures and/or osteoporosis and will be candidates for antiresorptive treatments. The noncancer treatment risk factors, screening and treatments for the management of osteopenia and osteoporosis are generally the same in postmenopausal women with and without breast cancer. However, premenopausal women with relatively rapid onset of treatment-related ovarian failure and bone loss pose several challenges. Awareness of treatment-related bone loss and risks of subsequent osteoporosis is a high priority in an ever-increasing population of breast cancer survivors.
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Affiliation(s)
- Loomee Doo
- Wexner College of Medicine, The Ohio State University, Columbus, OH, USA
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Valentini A, Finch A, Lubiński J, Byrski T, Ghadirian P, Kim-Sing C, Lynch HT, Ainsworth PJ, Neuhausen SL, Greenblatt E, Singer C, Sun P, Narod SA. Chemotherapy-induced amenorrhea in patients with breast cancer with a BRCA1 or BRCA2 mutation. J Clin Oncol 2013; 31:3914-9. [PMID: 23980083 PMCID: PMC3805929 DOI: 10.1200/jco.2012.47.7893] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the likelihood of long-term amenorrhea after treatment with chemotherapy in women with breast cancer who carry a BRCA1 or BRCA2 mutation. PATIENTS AND METHODS We conducted a multicenter survey of 1,954 young women with a BRCA1 or BRCA2 mutation who were treated for breast cancer. We included premenopausal women who were diagnosed with invasive breast cancer between 26 and 47 years of age. We determined the age of onset of amenorrhea after breast cancer for women who were and were not treated with chemotherapy, alone or with tamoxifen. We considered chemotherapy-induced amenorrhea to have occurred when the patient experienced ≥ 2 years of amenorrhea, commencing within 2 years of initiating chemotherapy, with no resumption of menses. RESULTS Of the 1,426 women who received chemotherapy, 35% experienced long-term amenorrhea. Of the 528 women who did not receive chemotherapy, 5.3% developed long-term amenorrhea. The probabilities of chemotherapy-induced amenorrhea were 7.2% for women diagnosed before age 30 years, 33% for women age 31 to 44 years, and 79% for women diagnosed after age 45 years (P trend < .001). The probability of induced amenorrhea was higher for women who received tamoxifen than for those who did not (52% v 29%; P < .001). CONCLUSION Age at treatment and use of tamoxifen are important predictors of chemotherapy-induced amenorrhea in women who carry a BRCA1 or BRCA2 mutation. The risk of induced long-term amenorrhea does not seem to be greater among mutation carriers than among women who do not carry a mutation.
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Affiliation(s)
- Adriana Valentini
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Amy Finch
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Jan Lubiński
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Tomasz Byrski
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Parviz Ghadirian
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Charmaine Kim-Sing
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Henry T. Lynch
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Peter J. Ainsworth
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Susan L. Neuhausen
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ellen Greenblatt
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christian Singer
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ping Sun
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Steven A. Narod
- Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Collins IM, Milne RL, McLachlan SA, Friedlander M, Hickey M, Weideman PC, Birch KE, Hopper JL, Phillips KA. Do BRCA1 and BRCA2 mutation carriers have earlier natural menopause than their noncarrier relatives? Results from the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer. J Clin Oncol 2013; 31:3920-5. [PMID: 24081944 DOI: 10.1200/jco.2013.49.3007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Limited data suggest that germline BRCA1 mutations are associated with occult primary ovarian insufficiency and that BRCA1 and BRCA2 mutation carriers might have earlier natural menopause (NM) than their noncarrier relatives. PATIENTS AND METHODS Eligible women were mutation carriers and noncarriers from families segregating a BRCA1 or BRCA2 mutation. Data were self-reported using uniform questionnaires at cohort entry and every 3 years thereafter. NM was defined as the cessation of menses for 12 months without another cause. Cox proportional hazards analysis modeled time from birth to NM, adjusting for multiple potential confounders. Analysis time was censored at the earliest of the following: last follow-up, bilateral oophorectomy, hysterectomy, commencement of hormone therapy, insertion of intrauterine device, or any cancer diagnosis. Hazard ratios (HRs) were estimated as a measure of how likely mutation carriers are, relative to noncarriers, to reach NM at a given age. RESULTS A total of 1,840 women were eligible for analysis. Overall only 19% reached NM. A lower proportion of BRCA1 and BRCA2 mutation carriers reached NM compared with noncarriers. Conversely, a higher proportion of mutation carriers were censored at cancer diagnosis or oophorectomy than noncarriers. The adjusted HR estimates for NM were 1.03 (95% CI, 0.75 to 1.40; P = .9) for 445 BRCA1 mutation carriers and 559 noncarrier relatives and 1.01 (95% CI, 0.71 to 1.42; P = .9) for 374 BRCA2 mutation carriers and 462 noncarrier relatives. CONCLUSION We found no evidence that BRCA1 and BRCA2 mutation carriers are at higher risk of NM at a given age than their noncarrier relatives.
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Affiliation(s)
- Ian M Collins
- Ian M. Collins, Sue Anne McLachlan, Prue Weideman, Kate E. Birch, and Kelly-Anne Phillips, Peter MacCallum Cancer Centre; Ian M. Collins, Roger L. Milne, Sue Anne McLachlan, Martha Hickey, John L. Hopper, and Kelly-Anne Phillips, University of Melbourne; Sue Anne McLachlan, St Vincent's Hospital; Martha Hickey, Royal Women's Hospital, Parkville, Melbourne; Michael Friedlander, Prince of Wales Hospital, Sydney, Australia; and John L. Hopper, Seoul National University, Seoul, Republic of Korea
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