title: Impact of tamoxifen therapy on fertility in breast cancer survivors.
abstract: To determine whether tamoxifen use is associated with decreased ovarian reserve and decreased likelihood of having a child after a breast cancer diagnosis, using data from the Furthering Understanding of Cancer, Health, and Survivorship in Adult (FUCHSIA) Women Study.
  
  
  
  Population-based cohort study.
  
  
  
  Not applicable.
  
  
  
  Three hundred ninety-seven female breast cancer survivors aged 22-45 years whose cancer was diagnosed between ages 20 and 35 years and who were at least 2 years after diagnosis; 108 survivors also participated in a clinic visit.
  
  
  
  None.
  
  
  
  Time to first child after cancer diagnosis, clinical measures of ovarian reserve (antimüllerian hormone [AMH] and antral follicle count [AFC]) after cancer.
  
  
  
  Women who had ever used tamoxifen were substantially less likely to have a child after the breast cancer diagnosis (hazard ratio [HR] 0.29; 95% confidence interval [CI], 0.16, 0.54) than women who had never used tamoxifen. After adjusting for age at diagnosis, exposure to an alkylating agent, and race, the HR was 0.25 (95% CI, 0.14, 0.47). However, after adjusting for potential confounders, women who had used tamoxifen had an estimated geometric mean AMH level 2.47 times higher (95% CI, 1.08, 5.65) than women who had never taken tamoxifen. Antral follicle count was also higher in the tamoxifen group compared with the tamoxifen nonusers when adjusted for the same variables (risk ratio 1.21; 95% CI, 0.84, 1.73).
  
  
  
  Breast cancer survivors who had used tamoxifen were less likely to have a child after breast cancer diagnosis compared with survivors who never used tamoxifen. However, tamoxifen users did not have decreased ovarian reserve compared with the tamoxifen nonusers.
authors.affiliation: School of Medicine, Atlanta, Georgia. Electronic address: Lisa.Shandley@emory.edu.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Shandley
authors.affiliation: Department of Gynecology and Obstetrics, School of Medicine, Atlanta, Georgia.
authors.forename: Jessica B
authors.initials: JB
authors.lastname: Spencer
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia.
authors.forename: Amy
authors.initials: A
authors.lastname: Fothergill
authors.affiliation: Aflac Cancer Center, Department of Pediatrics, School of Medicine, Atlanta, Georgia.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Mertens
authors.affiliation: Department of Biostatistics, Rollins School of Public Health, Atlanta, Georgia.
authors.forename: Amita
authors.initials: A
authors.lastname: Manatunga
authors.affiliation: Winship Cancer Institute, Department of Hematology and Medical Oncology, School of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Elisavet
authors.initials: E
authors.lastname: Paplomata
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia.
authors.forename: Penelope P
authors.initials: PP
authors.lastname: Howards
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005298:Fertility / Q000187:drug effects*; D005845:Georgia; D006801:Humans; D007247:Infertility, Female / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D006080:Ovarian Follicle / Q000000981:diagnostic imaging / Q000187:drug effects; D065851:Ovarian Reserve / Q000187:drug effects; D010298:Parity; D011247:Pregnancy; D012042:Registries; D012307:Risk Factors; D020845:Selective Estrogen Receptor Modulators / Q000009:adverse effects*; D017741:Survivors; D013629:Tamoxifen / Q000009:adverse effects*; D061685:Time-to-Pregnancy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D015415:Biomarkers; D020845:Selective Estrogen Receptor Modulators; D013629:Tamoxifen; D054304:Anti-Mullerian Hormone
keywords: Breast cancer; cancer survivorship; infertility; ovarian reserve; tamoxifen