Amenorrhea, fertility preservation, and counseling among young women treated with anthracyclines and taxanes for early-stage breast cancer, a retrospective study (original) (raw)
Related papers
Cancer and fertility preservation: fertility preservation in breast cancer patients
Breast Cancer Research, 2008
Aggressive chemotherapy has improved the life expectancy for reproductive-age women with breast cancer, but it often causes infertility or premature ovarian failure due to destruction of the ovarian reserve. Many questions concerning fertility preservation in breast cancer patients remain unanswered-for example, whether fertility preservation methods interfere with chemotherapy, and whether subsequent pregnancy has negative effects on the prognosis. Fertility preservation is a critical factor in decisionmaking for younger breast cancer patients, however, and clinicians should address this. The present article reviews the incidence of chemotherapy-induced amenorrhea, and discusses fertilitypreservation options and the prognosis for patients who become pregnant after breast cancer. This section discusses the effect on fertility of chemotherapy for breast cancer (Table 1) [4-13]. The risk of chemotherapyrelated amenorrhea depends on the patient's age, on the specific chemotherapeutic agents used, and on the total dose administered. Older women have a higher incidence of complete ovarian failure and permanent infertility in comparison with younger women [14]. This higher incidence can be explained by younger women's larger primordial follicle reserve, which declines with age. With regard to the chemotherapy regimen, according to Meirow, alkylating agents (for example, cyclophosphamide) involve the greatest risk for inducing ovarian failure among all chemotherapeutic agents (odds ratio 3.98 in comparison with unexposed patients) [15]. The higher the cumulative dose of cyclophosphamide, the higher the observed incidence of menopause. Goldhirsch and colleagues reported that, with the classic cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) regimen, the incidence of amenorrhea was 61% in patients aged <40 years and was 95% in patients aged >40 years [4]. The classic fluorouracil, epirubicin, and cyclophosphamide regimen (intravenous administration on day 1 of all drugs for
Best Practice & Research Clinical Obstetrics & Gynaecology, 2012
j o ur n a l ho m e pa g e : w w w. e l se v i e r . co m / l o ca t e / b po b g y n 1521-6934/$see front matter Ó
Fertility and Sterility, 2010
Fertility preservation is an important issue for young women diagnosed with breast cancer. The most well-established options for fertility preservation in cancer patients, embryo and oocyte cryopreservation, have not been traditionally offered to breast cancer patients as estradiol rise during standard stimulation protocols may not be safe for those patients. Potentially safer stimulation protocols using tamoxifen and aromatase inhibitors induce lower levels of estradiol while similar results in terms of number of oocyte and embryo obtained to standard protocols. Cryopreservation of immature oocytes and ovarian cortical tissue, both still experimental methods, are also fertility preservation options for breast cancer patients.
Fertility and outcomes of pregnancy after chemotherapy in a sample of childbearing aged women
Fundamental and Clinical Pharmacology, 2004
Following advances in the management of malignancies, cancer patients can realistically hope for cure and longterm survival. Exposure of women to potentially damaging agents, such as anti-cancer drugs, can have a dramatic effect on the fertility and reproductive issues. They accelerate the natural process of germ cell depletion and, as a direct consequence, advance the time to menopause, specifically in women aged over 40 years [1]. Cytotoxic chemotherapy, by depleting the follicular store, commonly produces menstrual irregularities, immediate or subsequent ovarian failure, and associated infertility .
Breast Cancer: Targets and Therapy, 2021
Over the last several decades, improvements in breast cancer treatment have contributed to increased cure rates for women diagnosed with this malignancy. Consequently, great importance should be paid to the long-term side effects of systemic therapies. For young women (defined as per guideline ≤40 years at diagnosis) who undergo chemotherapy, one of the most impactful side effects on their quality of life is premature ovarian insufficiency (POI) leading to fertility-related problems and the side effects of early menopause. Regimens, type, and doses of chemotherapy, as well as the age of patients and their ovarian reserve at the time of treatment are major risk factors for treatment-induced POI. For these reasons, childbearing desire and preservation of ovarian function and/or fertility should be discussed with all premenopausal patients before planning the treatments. This manuscript summarizes the available fertility preservation techniques in breast cancer patients, the risk of treatment-induced POI with different anticancer treatments, and the possible procedures to prevent it. A special focus is paid to the role of oncofertility counseling, as a central part of the visit in this setting, during which the patient should receive all the information about the potential consequences of the disease and of the proposed treatment on her future life.
Introduction: Anticancer treatments such as aggressive chemotherapy and radiotherapy have deleterious gonadotoxic side effects and are considered the most common causes of pathological and iatrogenic fertility loss in women. Areas Covered: In order to preserve fertility of young women and girls with cancer, several established, experimental, and debatable options can be offered in the emerging field of oncofertility. This article reviews the effects of anticancer treatments on female fertility and discusses the current challenges and future directions of fertility preservation options that can be offered to the female patients with cancer. Expert Commentary: Although promising, several medical, economic, social and legal barriers face oncofertility practice around the globe especially in underserved areas. To overcome such barriers, more effective solutions should be provided to spread awareness and enhance communication between patients, oncologists and gynecologists. Early referral by oncologists before initiation of chemotherapy and radiotherapy is an important key factor for success in female fertility preservation strategies.
Journal of Ovarian Research
Background: Breast 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. Methods: This 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). Results: A 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. Conclusions: Significant 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.