Incidence, Time Course, and Determinants of Menstrual Bleeding After Breast Cancer Treatment: A Prospective Study

Petrek, Jeanne A.; Naughton, Michelle J.; Case, L. Douglas; Paskett, Electra D.; Naftalis, Elizabeth; Singletary, S. Eva; Sukumvanich, Paniti

doi:10.1200/jco.2005.03.3969

Cited by 350 publications

(250 citation statements)

References 27 publications

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“…The instrument used in this study asked whether or not the patient had experienced menstruation in the previous 12 months and, if so, the date of that menstrual cycle. The use of patient calendars or diaries has been reported in several large clinical studies [12][13][14], and in this study women were given calendars for their own use, but calendar data were not collected. This approach allows uncertainty.…”

Section: Discussionmentioning

confidence: 99%

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Amenorrhea in premenopausal women on the doxorubicin-and-cyclophosphamide-followed-by-docetaxel arm of NSABP B-30 trial

Swain

Land

Ritter

et al. 2008

Breast Cancer Res Treat

104

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The NSABP B-30 trial addresses whether amenorrhea after adjuvant chemotherapy increases survival. Preliminary to the trial outcome analysis, we examined the incidence of amenorrhea and its relationship to symptoms and quality of life (QOL) in the standard-care arm of this adjuvant HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript breast cancer trial. Premenopausal women treated on the doxorubicin-and-cyclophosphamidefollowed-by-docetaxel arm were included. Questionnaires assessing menstrual history, QOL, and symptoms were administered at baseline, day 1 of cycle 4 (or 9 weeks from start of chemotherapy for those who stopped chemotherapy early), and at 6, 12, and 24 months. Seven hundred and eight patients were evaluable for the analysis, with median potential follow-up of 57.5 months. Of these, 321 patients also participated in the QOL substudy. Of the 708 patients, 83% reported ≥1 episode of amenorrhea for ≥6 months. The estimated rate of resumption of menses at 24 months was 45.3% for women<40 years, 10.9% for women 40-50, and 3.2% for women >50 years. Those treated with tamoxifen were more likely to become amenorrheic (p = 0.003). Menstrual status was not significantly associated with QOL or symptoms. Prolonged amenorrhea is associated with a regimen that contains doxorubicin, cyclophosphamide, and docetaxel, and is age dependent and impacted by tamoxifen use. Vasomotor symptoms are common in this patient population but are not associated with menstrual status. These results can be used to inform premenopausal women about the risk and time course of amenorrhea associated with this common adjuvant therapy regimen, along with the effects on symptoms and QOL.

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Section: Discussionmentioning

confidence: 99%

“…Another study evaluated menstrual bleeding in 595 women ≤45 years of age with stage I-III breast cancer who received either neoadjuvant or adjuvant chemotherapy [14]. This was a prospective study that evaluated monthly bleeding calendars and clinical, demographic, QOL, and treatment data.…”

Section: Discussionmentioning

confidence: 99%

Amenorrhea in premenopausal women on the doxorubicin-and-cyclophosphamide-followed-by-docetaxel arm of NSABP B-30 trial

Swain

Land

Ritter

et al. 2008

Breast Cancer Res Treat

104

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“…A prospective study by Petrek et al [5] used daily bleeding records to assess ovarian function in 595 breast cancer patients aged 20-45. In the month following completion of chemotherapy, approximately 16% patients had monthly bleeding on a standard course of doxorubicin and cyclophosphamide (whether or not followed by paclitaxel or doxetaxel) compared with 48% patients who received CMF.…”

Section: Introductionmentioning

confidence: 99%

Bone mineral density loss during adjuvant chemotherapy in pre-menopausal women with early breast cancer: is it dependent on oestrogen deficiency?

Cameron

Douglas

Brown

et al. 2010

Breast Cancer Res Treat

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mineral density loss during adjuvant chemotherapy in pre-menopausal women with early breast cancer: is it dependent on oestrogen deficiency?. Breast Cancer Research and Treatment, Springer Verlag, 2010, 123 (3) Pre-menopausal women given adjuvant chemotherapy for breast cancer experience both premature ovarian failure and loss of bone mineral density (BMD), and this study was designed to see if these observations are causally linked. MethodsChemotherapy was administered to 41 pre-menopausal women with early breast cancer enrolled prospectively in a study of ovarian function and BMD in such women given systemic therapy. After giving written informed consent, all patients underwent baseline and regular on-treatment measurements of BMD by dual-energy x-ray absorptiometry (DXA) scan, bone turnover and ovarian function by analysis of serum hormone levels and self-reported menstrual diaries. ResultsBaseline lumbar spine BMD in the 41 women given chemotherapy was higher than the normal population (Z score 0.28±0.14 (mean±sem), p=0.047), and fell significantly over the first six months from a mean of 1.05 to 1.01 g/m 2 , p <0.0001, and similar but smaller changes were demonstrated in hip BMD. This fall was independent of age at diagnosis, type of chemotherapy, development of amenorrhoea or either baseline or on-treatment estradiol concentration. During the six months after completion of adjuvant chemotherapy, BMD fell further only in those women with low estradiol or experiencing amenorrhoea during the first six months, although all groups showed evidence of increased bone turnover. ConclusionsThis study demonstrates loss of both spine and hip BMD in pre-menopausal women during six months' adjuvant systemic chemotherapy to be independent of changes in ovarian function. Ovarian function was however related to BMD changes after chemotherapy ceased.3

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“…Например, алкилирующие агенты, такие как цикло-фосфамид, являются причиной аменореи у 18-61% жен-щин моложе 40 лет и у 97% женщин старше 40 лет [15,20]. Доказана корреляция между увеличением кумулятивной дозы и дозоинтенсивной терапией и риском развития аменореи [4,17,19,23,24].…”

Section: химиоиндуцированная аменореяunclassified

Adjuvant Hormone Therapy Eligibility of Premenopausal Women With Er+ Breast Cancer

2017

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Адъювантная эндокринотерапия пременопаузальных пациентов с ER+-раком молочной железы обычно заключается в получении тамоксифена в течение 5 лет. Однако в случаях высокого риска рецидива заболевания возникает необходи-мость в подавлении (супрессии) функции яичников как основных генераторов эстрогенов, стимулирующих рост и про-грессирование заболевания, обычно с помощью агонистов гонадотропин-рилизинг-гормона. В результате наступившей медикаментозной постменопаузы становится возможным вместе с агонистами ГнРГ использовать не только тамоксифен, но и ингибиторы ароматазы, обладающие большей противоопухолевой активностью.

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Incidence, Time Course, and Determinants of Menstrual Bleeding After Breast Cancer Treatment: A Prospective Study

Cited by 350 publications

References 27 publications

Amenorrhea in premenopausal women on the doxorubicin-and-cyclophosphamide-followed-by-docetaxel arm of NSABP B-30 trial

Amenorrhea in premenopausal women on the doxorubicin-and-cyclophosphamide-followed-by-docetaxel arm of NSABP B-30 trial

Bone mineral density loss during adjuvant chemotherapy in pre-menopausal women with early breast cancer: is it dependent on oestrogen deficiency?

Adjuvant Hormone Therapy Eligibility of Premenopausal Women With Er+ Breast Cancer

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