The Impact Of Chemotherapy On Menstruation In Premenopausal Patients With Breast Cancer

Objective:the aim of our study is to investigage the incidence of chemotherapy-induced amenorrhea (CIA) and the subsequent recovery of the menses in premenopausal breast cancer patients, and to analyze the influence of patient characteristics on CIA and the recovery of menses, such as age at diagnose, age at menarche, reproductive history, anthropometrics, chemotherapy regimens, the use of tamoxifen, and so on.Methods:A follow-up questionnaire survey was conducted for premenopausal breast cancer women who were admitted to department of Breast Surgery in Qilu Hospital from January2010to January2012, to collect information on menstruation status, type and duration of chemotherapy, subsequent endocrine therapy and other treatments. Patients characteristics such as age at diagnoses, reproductive history, anthropometrics were collected from the medical records. Menses status after chemotherapy and risk factors for CIA were evaluated retrospectively.Result:A total of the286women with a median age of43years were participated in this study,10.1%(29/286) were young breast cancer patients(<35years). All patients were treated with standard chemotherapy, and CIA was present in60.1%with a median follow-up of21months. Menstrual cessation occurred after the third course of chemotherapy in86.6%of the patients who developed CIA. The frequency of CIA was significantly higher in older patients (≥35years) than patients whose age younger than35years (P=0.001). CIA was present in71.0%(22/31)of the women who had been treated with anthracycline-based chemotherapy regimens (CEF, EC, CTF), and59%(115/195)of the women who had been treated with anthracycline-taxanc. There were no statistically significant difference among the three different anthracycline and taxane containing regimens (ET, TEC, EC-T). The addition of taxane to anthracycline-based chemotherapy regimens didn’t statistically affect the incidence of CIA. Of the women who had been treated with TC (cyclophosphamide and taxane),60%(30/50) developed CIA, no statistically significant difference was found comparing with other regimens.85.17%(178/209) of the women who had endocrine adjuvant therapy used tamoxifen, and62.4%developed CIA, which was higher than patients without endocrine adjuvant therapy(54.1%), This difference did not reach statistical significance (P=0.220). Although a slightly higher incidence of CIA and menstrual change after chemotherapy (including Irregular menstruation and amenorrhea) in patients with receptor-positive breast cancer, the difference was not statistically significant. The reproductive history, age at menarche and BMI didn’t statistically affect incidence of CIA.37.8%of patients who developed CIA resumed bleeding. Patient characteristics such as age, BMI, age at menarche and chemotherapy regimen didn’t have statistically influence on the recovery of menses. Patients who used tamoxifen after chemotherapy had lower resumption of bleeding compared with patients without endocrine adjuvant therapy (P=0.497). Patients whose follow-up time were more than24months appear to have a statistically higher resumption of bleeding than patients whose follow-up time were shorter than24months(P=0.037).Conclusion:Menstrual cessation mostly occurred after the third course of chemotherapy in the patients who developed CIA. Age was significant factor for CIA. The reproductive history, age at menarche, BMI and hormone receptor status didn’t statistically affect incidence of CIA and the recovery of menses. Chemotherapy regimen and the sequential use didn’t have statistically influence on CIA and the recovery of menses. A part of patients who developed CIA didn’t have menses even after a long time of amenorrhea while others resume bleeding, and the time course of bleeding have individual difference.