Amenorrhea and Menopause in Patients with Breast Cancer after Chemotherapy

Abstract

PurposeThe probability of ovarian failure after cytotoxic chemotherapy in patients with breast cancer has not been well established in Korea. This study aimed to assess the rate of ovarian failure in a large cohort of Korean premenopausal patients with breast cancer 12 months after chemotherapy.MethodsThis retrospective cohort study included premenopausal women (aged 20−44 years) with breast cancer who underwent chemotherapy after surgery. The rates of treatment-related amenorrhea (TRA) and chemotherapy-induced menopause (CIM) at 12 months after chemotherapy were analyzed.ResultsA total of 237 patients met the inclusion criteria. The rate of TRA was 61.6% and that of CIM was 13.1% at 12 months after chemotherapy. The rates of TRA and CIM were 28.0% and 4.0%, respectively, in women aged 25−34 years, and they gradually increased up to 75.9% (TRA) and 15.8% (CIM), respectively, in women aged 40−44 years. The frequency of CIM was significantly lower than that of TRA in both age groups. In multivariate analyses, only tamoxifen use was significantly associated with a decreased risk of CIM (p < 0.001). Age of 40 years or higher and the regimens of doxorubicin plus cyclophosphamide followed by docetaxel or paclitaxel were associated with increased risk of TRA (p = 0.001 and p = 0.002, respectively).ConclusionMarked discrepancy in the rates of CIM and TRA was observed in this study. Further, the age-specific frequency of CIM and TRA observed in this study is a reliable and practical estimate of the risks of CIM and TRA in the absence of gonadal protection.

Prevalence and Potential Factors Related to Irreversible Chemotherapy-Induced Amenorrhea in Premenopausal Breast Cancer Patients

“…Regarding independent factors related to CIA, our study revealed only age older than 45 years-old impacted irreversible CIA. This result was similar to previous reports that showed younger ages related to the resumption of menstruation [6][7][8][9][10]. However, Meng et al [10] published their study about this issue in 73 premenopausal breast cancer women who received adjuvant chemotherapy for early-stage breast cancer (Stages I-III) and found that CIA significantly related to age at diagnosis and tamoxifen usage.…”

“…This difference might be from the variant of the number of participants and the chemotherapy regimens. Moreover, Shin et al [8] recently reported the rate of CIA in 237 premenopausal Korean breast cancer women aged 20-44 years who treated with chemotherapy after surgery. They found the rate of CIA as 61.6% and the rate of irreversible CIA was 13.1% at one year.…”

Breast cancer: Muscarinic receptors as new targets for tumor therapy

“…The treatment with doxorubicin causes many side effects, including cardiotoxicity[ 186 ], infertility[ 187 ], genotoxicity[ 188 ], amenorrhea[ 189 ], thrombophlebitis[ 190 ] and lung embolism[ 191 ]. Regarding cardiotoxicity, the additional challenge is that it can occur 10 years after chemotherapy treatment, appearing as a progressive congestive cardiac failure secondary to a non-ischemic dilated cardiomyopathy, and is irreversible and usually fatal[ 192 , 193 ].…”

Managing menopausal symptoms in patients with hormone receptor-positive gynecologic cancers

“…По данным V. Tiong и соавт., аменорея носит обратимый характер у 50% пациенток в возрасте до 35 лет, 31,6% в возрасте 35-45 лет и 14,9% у пациенток старше 45 лет [23]. Через 12 мес после окончания химиотерапии аменорея была выявлена в 61,6% (из них в возрасте 25-34 года -28,0%, у женщин 40-44 лет -75,9%), а частота менопаузы, индуцированной химиотерапией, со-ставила 13,1% (4,0 и 15,8% соответственно) [24]. У женщин старше 40 лет через 2 года после начала химиотерапии менопауза наступала в 5,6%, у женщин моложе 40 лет -в 8,7% случаев [25].…”

“…Низкий риск преждевременной недостаточности яичников зарегистрирован при лечении метотрексатом, 5-фторурацилом, блеомицином и винкристином [26]. Безусловно, проведение полихимиотерапии повышает риск развития менопаузы [24]. Кроме того, имеет значение фаза менструального цикла на момент проведения химиотерапии.…”