BACKGROUND: The likelihood of premature menopause has not been thoroughly explored in women who remain premenopausal after adjuvant chemotherapy for breast cancer. METHODS: We used data from the International Breast Cancer Study Group (IBCSG) Trials V and VI. Trial V enrolled 1407 eligible premenopausal women randomised tono systemic therapy (No CT) or 1 cycle of perioperative CMF-based chemotherapy (PeCT) if node negative, and 6 cycles of CMF-based chemotherapy postoperatively (CMFx6) or 1 cycle perioperative CMF-based chemotherapy plus CMFx6 postoperatively (CMFx7) if node positive. From Trial VI (a 2x2 factorial designed study of 3 versus 6 initial cycles of CMF and a reintroduction of three additional courses of CMF), we included 375 women randomised to receive only six initial cycles ofCMF (CMFx6). FINDINGS: We excluded women who reported no menses during 12-24 months after randomisation (N=934), hysterectomy (N=16) or bilateral oophorectomy (N=8), or missing menses data (N=57), creating a cohort of 767 women; 540 women had been randomised to PeCT or no CT, 227 randomised to CMFx6 or 7. A Cox proportional hazards model revealed that CMFx6 or 7 (HR=2.03, p<0.0001) and temporary amenorrhea (HR=1.96, p<0.0001) were associated with premature menopause. INTERPRETATION:Women who remain premenopausal after 6 or 7 cycles of CMF-based chemotherapy have a higher likelihood of going through menopause at an earlier age than women who received little or no chemotherapy. Temporary cessation of menses appears to be a marker for earlier onset of menopause. These findings may assist women and clinicians when making treatment and reproductive decisions after a diagnosis of breast cancer.
RCT Entities:
BACKGROUND: The likelihood of premature menopause has not been thoroughly explored in women who remain premenopausal after adjuvant chemotherapy for breast cancer. METHODS: We used data from the International Breast Cancer Study Group (IBCSG) Trials V and VI. Trial V enrolled 1407 eligible premenopausal women randomised to no systemic therapy (No CT) or 1 cycle of perioperative CMF-based chemotherapy (PeCT) if node negative, and 6 cycles of CMF-based chemotherapy postoperatively (CMFx6) or 1 cycle perioperative CMF-based chemotherapy plus CMFx6 postoperatively (CMFx7) if node positive. From Trial VI (a 2x2 factorial designed study of 3 versus 6 initial cycles of CMF and a reintroduction of three additional courses of CMF), we included 375 women randomised to receive only six initial cycles of CMF (CMFx6). FINDINGS: We excluded women who reported no menses during 12-24 months after randomisation (N=934), hysterectomy (N=16) or bilateral oophorectomy (N=8), or missing menses data (N=57), creating a cohort of 767 women; 540 women had been randomised to PeCT or no CT, 227 randomised to CMFx6 or 7. A Cox proportional hazards model revealed that CMFx6 or 7 (HR=2.03, p<0.0001) and temporary amenorrhea (HR=1.96, p<0.0001) were associated with premature menopause. INTERPRETATION:Women who remain premenopausal after 6 or 7 cycles of CMF-based chemotherapy have a higher likelihood of going through menopause at an earlier age than women who received little or no chemotherapy. Temporary cessation of menses appears to be a marker for earlier onset of menopause. These findings may assist women and clinicians when making treatment and reproductive decisions after a diagnosis of breast cancer.
Authors: Giuliano M Bedoschi; Felipe Oliveira de Albuquerque; Rui Alberto Ferriani; Paula Andrea Navarro Journal: J Assist Reprod Genet Date: 2010-05-09 Impact factor: 3.412
Authors: Jessica R Gorman; Anne K Julian; Samantha A Roberts; Sally A D Romero; Jennifer L Ehren; Michael L Krychman; Sarah G Boles; Jun Mao; H Irene Su Journal: Support Care Cancer Date: 2017-09-14 Impact factor: 3.603
Authors: Melanie H Jacobson; Ann C Mertens; Jessica B Spencer; Amita K Manatunga; Penelope P Howards Journal: Fertil Steril Date: 2015-12-01 Impact factor: 7.329