Adverse reproductive health outcomes in a cohort of young women with breast cancer exposed to systemic treatments
Abstract 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 importa...
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| Format: | Article |
| Language: | English |
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BMC
2019-10-01
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| Series: | Journal of Ovarian Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13048-019-0581-6 |
| _version_ | 1797970615099981824 |
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| author | Cristina Silva Ana Cristina Ribeiro Rama Sérgio Reis Soares Mariana Moura-Ramos Teresa Almeida-Santos |
| author_facet | Cristina Silva Ana Cristina Ribeiro Rama Sérgio Reis Soares Mariana Moura-Ramos Teresa Almeida-Santos |
| author_sort | Cristina Silva |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-11T03:18:48Z |
| format | Article |
| id | doaj.art-e951d643b26e4a1183d1a8ecb83383a9 |
| institution | Directory Open Access Journal |
| issn | 1757-2215 |
| language | English |
| last_indexed | 2024-04-11T03:18:48Z |
| publishDate | 2019-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Ovarian Research |
| spelling | doaj.art-e951d643b26e4a1183d1a8ecb83383a92023-01-02T09:39:50ZengBMCJournal of Ovarian Research1757-22152019-10-0112111010.1186/s13048-019-0581-6Adverse reproductive health outcomes in a cohort of young women with breast cancer exposed to systemic treatmentsCristina Silva0Ana Cristina Ribeiro Rama1Sérgio Reis Soares2Mariana Moura-Ramos3Teresa Almeida-Santos4Pharmacology Department, Faculty of Pharmacy, University of CoimbraPharmaceutical Services, Centro Hospitalar e Universitário de Coimbra (CHUC), EPEIVI ClinicReproductive Medicine Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), EPEReproductive Medicine Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), EPEAbstract 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.http://link.springer.com/article/10.1186/s13048-019-0581-6Breast cancerChemotherapyOvarian reserveAnti-mullerian hormoneInfertilityOncofertility |
| spellingShingle | Cristina Silva Ana Cristina Ribeiro Rama Sérgio Reis Soares Mariana Moura-Ramos Teresa Almeida-Santos Adverse reproductive health outcomes in a cohort of young women with breast cancer exposed to systemic treatments Journal of Ovarian Research Breast cancer Chemotherapy Ovarian reserve Anti-mullerian hormone Infertility Oncofertility |
| title | Adverse reproductive health outcomes in a cohort of young women with breast cancer exposed to systemic treatments |
| title_full | Adverse reproductive health outcomes in a cohort of young women with breast cancer exposed to systemic treatments |
| title_fullStr | Adverse reproductive health outcomes in a cohort of young women with breast cancer exposed to systemic treatments |
| title_full_unstemmed | Adverse reproductive health outcomes in a cohort of young women with breast cancer exposed to systemic treatments |
| title_short | Adverse reproductive health outcomes in a cohort of young women with breast cancer exposed to systemic treatments |
| title_sort | adverse reproductive health outcomes in a cohort of young women with breast cancer exposed to systemic treatments |
| topic | Breast cancer Chemotherapy Ovarian reserve Anti-mullerian hormone Infertility Oncofertility |
| url | http://link.springer.com/article/10.1186/s13048-019-0581-6 |
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