Adverse reproductive health outcomes in a cohort of young women with breast cancer exposed to systemic treatments

Abstract

BackgroundBreast cancer is the most common cancer in young women. Fortunately current survival rates of BC are significant which makes future fertility very important for quality of life of BC survivors. Chemotherapy carries a significant risk of infertility in BC patients so it is important to support fertility preservation decisions in premenopausal women. Amenorrhea has long been used as a surrogate marker of infertility in cancer patients but more reliable ovarian reserve (OR) markers are available. This study aimed to prospectively measure levels of OR in a cohort of young women with breast cancer exposed to chemotherapy, to identify adverse reproductive health outcomes in this population and to assess the influence of patient and treatment-related factors in those outcomes.MethodsThis prospective observational study included premenopausal women with breast cancer aged 18–40 years at diagnosis and proposed for (neo) adjuvant chemotherapy. Patients were evaluated before, during and a minimum of 9 months after the end of chemotherapy. Reproductive health outcomes: menses, hormonal and ultrasound OR markers, recovery of ovarian function and Premature Ovarian Insufficiency (POI).ResultsA total of 38 patients were included (mean age 32.9 ± 3.5 years). Levels of OR significantly decreased during the study. At the last follow up, 35 patients had AMH below the expected values for age; eight presented postmenopausal FSH; ten had not recovered their ovarian function and five met the defined criteria for POI. Age and baseline AMH were positively correlated with AMH at the last follow-up. AMH levels were higher in the group of patients treated with trastuzumab and lower in those under hormonal therapy, at the last follow-up.ConclusionsSignificant effects of systemic treatments on several reproductive outcomes and a strong relation of those outcomes with patient’s age and baseline level of AMH were observed. Our results point to a possible lower gonadotoxicity when treatment includes targeted therapy with trastuzumab. Also, this investigation highlights the lack of reliable OR markers in women under hormonal therapy.

A crosscut survey on reproductive health in Lithuanian childhood cancer survivors

“…Thirty-four (9.8%) respondents (17 males and 17 females) were included into the final analysis. The median age at the time of evaluation was 27 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) years, meanwhile the one at cancer diagnosis -13 (2-18) years. The age did not differ between males and females (Tab.…”

Nationwide survey of Japanese breast oncology and reproductive endocrinology departments about the impact of breast cancer treatment on fertility

“…8 The decline in both ovarian function and endometrial receptivity for embryos in women treated for breast cancer is of concern. [9][10][11][12][13][14][15] The purpose of our study was to investigate the fertility of Japanese women who undergo treatment for breast cancer. We conducted a nationwide survey of board-certified breast specialists and reproductive endocrinologists to investigate the subsequent fertility of patients after treatment for breast cancer.…”

“…The decline in both ovarian function and endometrial receptivity for embryos in women treated for breast cancer is of concern 9–15 . The purpose of our study was to investigate the fertility of Japanese women who undergo treatment for breast cancer.…”

Sintomas geniturinários em mulheres com câncer de mama em tratamento quimioterápico

“…Os sintomas geniturinários ocasionados pelos quimioterápicos são decorrentes da redução do hormônio estrogênio e consequente déficit nos receptores α e β presentes na vagina, vulva, músculos do assoalho pélvico (MAP), fáscia endopélvica, uretra e trígono vesical. A deficiência de estrogênio apresenta respostas sobre o tônus e o trofismo do assoalho pélvico, trato urinário inferior e genitália, podendo resultar em alterações na fisiologia da continência urinária e na função sexual (TINELLI et al, 2005;MARQUES;SILVA;AMARAL, 2011).…”

“…Esta alteração de função ovariana induzida pelo quimioterápico pode promover alterações do tônus e trofismo do AP(TINELLI et al2005;MARQUES;SILVA;AMARAL, 2011); confirmando a necessidade de avaliação dos MAP, envolvidos tanto na continência urinária quanto na função sexual.…”