Endocrine therapy and urogenital outcomes among women with a breast cancer diagnosis.
Endocrine therapy for breast cancer can exacerbate menopausal symptoms. The association between endocrine therapy and common pelvic floor disorders including urinary incontinence has rarely been evaluated. We examined urogenital and sexual side effects among women with a breast cancer diagnosis, comparing endocrine therapy users to nonusers.



Urogenital and sexual symptoms were self-reported during the enrollment interview within the University of North Carolina Cancer Survivorship Cohort. Tumor characteristics and endocrine therapy use were collected from medical and prescription records. We calculated multivariable prevalence ratios (PR) and 95 % confidence intervals (CI) for the association of endocrine therapy (versus no endocrine therapy) and urinary incontinence, overall and by therapy type (tamoxifen or aromatase inhibitors). PROMIS Sexual Function and Satisfaction domain scores were compared across endocrine therapy groups.



Among the 548 women with a breast cancer diagnosis, 49 % received endocrine therapy. Overall, 18 % of women reported urinary incontinence symptoms. We observed no association between urinary incontinence and endocrine therapy use overall (PR = 0.97; 95 % CI 0.67, 1.43), tamoxifen (PR = 1.20; 95 % CI 0.74, 1.96), or aromatase inhibitors (PR = 0.89; 95 % CI 0.55, 1.42), compared to no use. Approximately 55 % of women were sexually active. Sexual function scores did not vary according to endocrine therapy use, although urinary incontinence was associated with lower satisfaction scores (p = 0.05).



Our findings demonstrate a high prevalence of urinary incontinence after breast cancer diagnosis similar to the overall prevalence in older U.S. women, and this did not vary strongly according to use of endocrine therapy.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7435, USA. slandi@email.unc.edu.
Suzanne N
SN
Landi
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 170 Rosenau Hall, Chapel Hill, NC, 27599-7400, USA.|Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599-7295, USA.
Kemi M
KM
Doll
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7435, USA.|Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599-7295, USA.
Jeannette T
JT
Bensen
Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599-7295, USA.
Laura
L
Hendrix
Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599-7295, USA.
Carey K
CK
Anders
Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, 3032 Old Clinic Building, Chapel Hill, NC, 27599-7570, USA.
Jennifer M
JM
Wu
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7435, USA.
Hazel B
HB
Nichols
D000368:Aged; D047072:Aromatase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D012735:Sexual Dysfunction, Physiological / Q000139:chemically induced* / Q000453:epidemiology; D013629:Tamoxifen / Q000009:adverse effects* / Q000627:therapeutic use; D014549:Urinary Incontinence / Q000139:chemically induced* / Q000453:epidemiology
D047072:Aromatase Inhibitors; D013629:Tamoxifen
Cancer survivors; Endocrine therapy; Patient-reported outcomes; Sexual function; Urinary incontinence
Anticancer Drugs. 2004 Sep;15(8):753-60
15494636
Cochrane Database Syst Rev. 2012 Oct 17;10:CD001405
23076892
Lancet Oncol. 2006 Aug;7(8):633-43
16887480
Breast Cancer Res Treat. 2013 Aug;141(1):111-7
23942873
BMC Cancer. 2013 Aug 07;13:377
23924272
Climacteric. 2007 Jun;10(3):244-8
17487651
Folia Histochem Cytobiol. 2011;49(3):521-7
22038234
JAMA. 2008 Sep 17;300(11):1311-6
18799443
J Sex Med. 2013 Feb;10 Suppl 1:43-52
23387911
Am J Obstet Gynecol. 2011 Jan;204(1):26.e1-7
20950790
Climacteric. 2005 Sep;8(3):214-20
16390753
Breast Cancer Res Treat. 2006 Dec;100(3):273-84
16944295
Clin Breast Cancer. 2009 May;9(2):108-17
19433392
JAMA. 2005 Feb 23;293(8):935-48
15728164
J Clin Oncol. 2006 Feb 20;24(6):910-7
16484701
J Am Geriatr Soc. 2015 May;63(5):947-53
25940401
J Clin Oncol. 2014 Jul 20;32(21):2255-69
24868023
Med Care. 2003 May;41(5):582-92
12719681