title: Early menopause in long-term survivors of cancer during adolescence.
abstract: OBJECTIVE
  We attempted to investigate the risk of early menopause after treatment for cancer during childhood or adolescence.
  
  
  METHODS
  We interviewed 1067 women in whom cancer was diagnosed before age 20, who were at least 5-year survivors, and who were still menstruating at age 21. Self-reported menopause status in survivors was compared with that in 1599 control women.
  
  
  RESULTS
  Cancer survivors, with disease diagnosed between ages 13 and 19, had a risk of menopause four times greater than that of controls during the ages 21 to 25; the risk relative to controls declined thereafter. Significantly increased relative risks of menopause during the early 20s occurred after treatment with either radiotherapy alone (relative risk 3.7) or alkylating agents alone (relative risk 9.2). During ages 21 to 25 the risk of menopause increased 27-fold for women treated with both radiation below the diaphragm and alkylating agent chemotherapy. By age 31, 42% of these women had reached menopause compared with 5% for controls.
  
  
  CONCLUSIONS
  Treatment for cancer during adolescence carries a substantial risk for early menopause among women still menstruating at age 21. Increasing use of radiation and chemotherapy, together with the continued trend toward delayed childbearing, suggests that these women should be made aware of their smaller window of fertility so that they can plan their families accordingly.
authors.affiliation: Clinical Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892.
authors.forename: J
authors.initials: J
authors.lastname: Byrne
authors.forename: T R
authors.initials: TR
authors.lastname: Fears
authors.forename: M H
authors.initials: MH
authors.lastname: Gail
authors.forename: D
authors.initials: D
authors.lastname: Pee
authors.forename: R R
authors.initials: RR
authors.lastname: Connelly
authors.forename: D F
authors.initials: DF
authors.lastname: Austin
authors.forename: G F
authors.initials: GF
authors.lastname: Holmes
authors.forename: F F
authors.initials: FF
authors.lastname: Holmes
authors.forename: H B
authors.initials: HB
authors.lastname: Latourette
authors.forename: J W
authors.initials: JW
authors.lastname: Meigs
mesh_terms: D000328:Adult; D000477:Alkylating Agents / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006689:Hodgkin Disease / Q000209:etiology; D006801:Humans; D008594:Menopause, Premature; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D009381:Neoplasms, Radiation-Induced; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000477:Alkylating Agents