title: Early menopause and infertility in females after treatment for childhood cancer diagnosed in 1964-1988 in Ontario, Canada.
abstract: This study was conducted to determine the risk of menopause and infertility in female childhood cancer survivors who received abdominal-pelvic radiation and/or chemotherapy with alkylating agents in comparison with those who were treated by nonsterilizing surgery only. Females who were diagnosed in 1964-1988 before age 20 years with a histologically confirmed malignancy and who had survived for at least 5 years, had attained age 18, and were alive at time of study were identified through the Ontario Cancer Registry. Reproductive outcomes were ascertained by a telephone-administered questionnaire, and treatment data were abstracted from medical records for 830 subjects aged 18-49 years; 719 survivors who were nonmenopausal at the end of treatment were included in the analyses. Survivors who received both alkylating agents and abdominal-pelvic radiation were more likely to be postmenopausal than were those who underwent surgery (risk ratio = 2.58; 95% confidence interval: 1.14, 5.80). Women treated with abdominal-pelvic radiation alone had a fertility deficit of 23% compared with those in the surgery group; the deficit was restricted to women diagnosed postpuberty. Risks of menopause and infertility increased with increasing dose of abdominal-pelvic radiation and amount of alkylating agent.
authors.affiliation: Department of Public Health Sciences, University of Toronto, Ontario, Canada.
authors.forename: A M
authors.initials: AM
authors.lastname: Chiarelli
authors.forename: L D
authors.initials: LD
authors.lastname: Marrett
authors.forename: G
authors.initials: G
authors.lastname: Darlington
mesh_terms: D000005:Abdomen; D000293:Adolescent; D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007223:Infant; D007247:Infertility, Female / Q000209:etiology*; D008594:Menopause, Premature; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D009864:Ontario; D010388:Pelvis; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000009:adverse effects*; D012042:Registries; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D018906:Antineoplastic Agents, Alkylating