title: Treatment-related amenorrhea and sexual functioning in young breast cancer survivors.
abstract: BACKGROUND
  Sexual dysfunction is a known complication of adjuvant therapy for breast cancer and an important determinant of quality of life. However, few studies have explored how treatment and other factors affect sexual functioning in young breast cancer survivors.
  
  
  METHODS
  Four hundred sixty-one premenopausal women with stage 0 through III breast cancer were surveyed an average of 1 year after diagnosis as part of a prospective cohort study of women who were aged ≤40 years at diagnosis. Sexual interest and dysfunction were assessed using the Cancer Rehabilitation Evaluation System (CARES). Mean CARES scores were compared and multiple regression models were fit to assess treatment and a range of menopausal and somatic symptoms in relation to sexual functioning.
  
  
  RESULTS
  Mean CARES sexual interest and dysfunction scores were both highest (indicating poorer functioning) among women who received chemotherapy and were amenorrheic from treatment. After accounting for menopausal and somatic symptoms, treatment-associated amenorrhea remained associated with decreased interest but was no longer an independent predictor of dysfunction. In the multivariable analysis, independent predictors of dysfunction included vaginal pain symptoms, poorer body image, and fatigue. Sexual interest was associated with vaginal pain symptoms, body image, and weight problems.
  
  
  CONCLUSIONS
  Factors associated with decreased sexual functioning in young breast cancer survivors can often be ameliorated. The current findings have implications for premenopausal women with other types of cancer who might be experiencing amenorrhea because of chemotherapy or surgery. Increased awareness and early intervention is essential to help improve sexual functioning and associated quality of life for all young cancer survivors.
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts; Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Shoshana M
authors.initials: SM
authors.lastname: Rosenberg
authors.forename: Rulla M
authors.initials: RM
authors.lastname: Tamimi
authors.forename: Shari
authors.initials: S
authors.lastname: Gelber
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Ruddy
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Bober
authors.forename: Sandra
authors.initials: S
authors.lastname: Kereakoglow
authors.forename: Virginia F
authors.initials: VF
authors.lastname: Borges
authors.forename: Steven E
authors.initials: SE
authors.lastname: Come
authors.forename: Lidia
authors.initials: L
authors.lastname: Schapira
authors.forename: Ann H
authors.initials: AH
authors.lastname: Partridge
mesh_terms: D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000209:etiology* / Q000503:physiopathology*; D001943:Breast Neoplasms / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D011446:Prospective Studies; D012725:Sexual Behavior / Q000502:physiology*; D055815:Young Adult
keywords: amenorrhea; breast cancer; chemotherapy; premenopausal; sexual dysfunction