Incidence of chemotherapy-induced ovarian failure in premenopausal women undergoing chemotherapy for breast cancer.
BACKGROUND
Breast cancer is increasingly reported in young premenopausal women in Asia. Adjuvant chemotherapy improves survival; however, it has a unique consequence of ovarian failure in premenopausal patients.


OBJECTIVE
This study's aim was to find the incidence of chemotherapy-induced ovarian failure (CIOF) and reversible amenorrhea in premenopausal non-metastatic breast cancer patients.


METHODS
This mixed retrospective and prospective study follows premenopausal breast cancer patients receiving chemotherapy between 2008 and 2012. Patients in the prospective arm were followed up with menstrual history and serum ovarian hormones (follicle-stimulating hormone [FSH] and estradiol) until 1 year post-chemotherapy, and patients in the retrospective arm were contacted for their menstrual history.


RESULTS
The mean age of the 102 subjects was 43.3 years. Of the patients, 93.1 and 77.9 % were amenorrheic at completion of chemotherapy and at 12 months post-chemotherapy, respectively. Of those who developed amenorrhea, 24.6 % regained menstruation, on average after 7.86 (range 1-15) months post-chemotherapy. Age was the only statistically significant risk factor. CIOF and reversible amenorrhea was 57 and 50 % at <35 years, 95 and 31.6 % at 35-45 years, and 97.9 and 14.9 % at >50 years, respectively. The 33 prospective patients' estradiol and FSH levels seem to correlate well with onset of amenorrhea, with a falling estradiol and rising FSH trend. Tamoxifen use was associated with elevated estradiol levels 1 year post-chemotherapy.


CONCLUSIONS
This study found a high incidence of CIOF, with a relatively low rate of reversible amenorrhea. Premenopausal patients should be counselled prior to treatment and education and support provided.
Department of Surgery, University Malaya, 50603, Kuala Lumpur, Malaysia, vune@hotmail.com.
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Tiong
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Rozita
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Taib
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Yip
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Ng
D000328:Adult; D000367:Age Factors; D000568:Amenorrhea / Q000097:blood / Q000139:chemically induced*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001208:Asia; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage; D000077143:Docetaxel; D015251:Epirubicin / Q000008:administration & dosage; D004958:Estradiol / Q000097:blood; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D015994:Incidence; D060828:Induction Chemotherapy; D008598:Menstruation / Q000187:drug effects; D008875:Middle Aged; D017697:Premenopause; D016649:Primary Ovarian Insufficiency / Q000097:blood / Q000139:chemically induced*; D011446:Prospective Studies; D012189:Retrospective Studies; D013629:Tamoxifen / Q000008:administration & dosage; D043823:Taxoids / Q000008:administration & dosage; D055815:Young Adult
D043823:Taxoids; D013629:Tamoxifen; D000077143:Docetaxel; D015251:Epirubicin; D004958:Estradiol; D003520:Cyclophosphamide; D005640:Follicle Stimulating Hormone; D005472:Fluorouracil