Chemotherapy-Related Amenorrhea and Menopause in Young Chinese Breast Cancer Patients: Analysis on Incidence, Risk Factors and Serum Hormone Profiles.
OBJECTIVE
In this prospective cross-sectional study on young premenopausal breast cancer patients, the objectives were to: determine the incidences of chemotherapy-related amenorrhea (CRA) and menopause (CRM); identify associated factors; and assess plasma levels of estradiol (E2) and follicular stimulating hormone (FSH) among patients who developed menopause.


METHODS
Eligibility criteria include Chinese stage I-III breast cancer patients, premenopausal, age ≤45 at breast cancer diagnosis, having received adjuvant chemotherapy, within 3-10 years after breast cancer diagnosis. Detailed menstrual history prior to and after adjuvant treatment was taken at study entry. Patients' background demographics, tumor characteristics and anti-cancer treatments were collected. The rates of CRA and CRM were determined. Analysis was conducted to identify factors associated with CRM. For postmenopausal patients, levels of E2 and FSH were analyzed.


RESULTS
286 patients were recruited; the median time from breast cancer diagnosis to study entry was 5.0 years. 255 patients (91.1%) developed CRA. Of these, 66.7% regained menstruation. At the time of study entry, 137 (48.9%) had developed CRM, amongst whom 84 were age ≤45. On multivariate analysis, age was the only associated factor. Among patients with CRM, the median FSH was 41.0 IU/L; this was significantly lower in those who were taking tamoxifen compared to those who were not (20.1 vs. 59.7 IU/L, p<0.0001). The E2 level was <40 pmol/L; there was no difference between those who were still on tamoxifen or not.


CONCLUSIONS
After adjuvant chemotherapy, the majority of young Chinese breast cancer patients developed CRA; ~50% developed CRM, with 61% at age ≤45. Age at diagnosis is the only factor associated with CRM. FSH level may be affected by tamoxifen intake.
Department of Clinical Oncology and Comprehensive Cancer Trials Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Giok S
GS
Liem
Department of Clinical Oncology and Comprehensive Cancer Trials Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Frankie K F
FK
Mo
Department of Clinical Oncology and Comprehensive Cancer Trials Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Elizabeth
E
Pang
Department of Clinical Oncology and Comprehensive Cancer Trials Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Joyce J S
JJ
Suen
Department of Chemical Pathology and Li Ka Shing Institute of Health Science, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China; Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Nelson L S
NL
Tang
Department of Clinical Oncology and Comprehensive Cancer Trials Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Kun M
KM
Lee
Department of Clinical Oncology and Comprehensive Cancer Trials Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Claudia H W
CH
Yip
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Wing H
WH
Tam
Department of Clinical Oncology and Comprehensive Cancer Trials Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Rita
R
Ng
Department of Clinical Oncology and Comprehensive Cancer Trials Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Jane
J
Koh
Department of Clinical Oncology and Comprehensive Cancer Trials Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Christopher C H
CC
Yip
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Grace W S
GW
Kong
Department of Clinical Oncology and Comprehensive Cancer Trials Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Winnie
W
Yeo
D000328:Adult; D000568:Amenorrhea / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000097:blood / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D002681:China; D003430:Cross-Sectional Studies; D004958:Estradiol / Q000097:blood*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D015994:Incidence; D008594:Menopause, Premature / Q000097:blood*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013629:Tamoxifen / Q000009:adverse effects* / Q000627:therapeutic use; D055815:Young Adult
D000970:Antineoplastic Agents; D013629:Tamoxifen; D004958:Estradiol; D005640:Follicle Stimulating Hormone