Adverse reproductive health outcomes in a cohort of young women with breast cancer exposed to systemic treatments

• Published in: Journal of ovarian research Vol. 12; no. 1; p. 102
• Main Authors: Silva, Cristina, Ribeiro Rama, Ana Cristina, Reis Soares, Sérgio, Moura-Ramos, Mariana, Almeida-Santos, Teresa
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 31.10.2019; BioMed Central; BMC
• Subjects: Adjuvant chemotherapy; Adolescent; Adult; Age Factors; Amenorrhea; Anti-mullerian hormone; Biomarkers; Breast cancer; Breast Neoplasms - complications; Breast Neoplasms - epidemiology; Breast Neoplasms - metabolism; Breast Neoplasms - therapy; Cancer patients; Cancer research; Cancer treatment; Causes of; Chemotherapy; Combined Modality Therapy - adverse effects; Combined Modality Therapy - methods; Complications and side effects; Drug therapy; Female; Female infertility; Follow-Up Studies; Hormones; Humans; Infertility; Medical research; Menopause; Menstruation; Oncofertility; Ovarian Reserve; Patient Outcome Assessment; Patient outcomes; Postmenopausal women; Premenopause; Primary Ovarian Insufficiency - epidemiology; Primary Ovarian Insufficiency - etiology; Prospective Studies; Public Health Surveillance; Quality of Life; Reproductive health; Reproductive Health - statistics & numerical data; Women; Young Adult; Young women; Portugal; Chemotherapy; Fertility preservation; Oncofertility; Infertility; Breast cancer; Anti-mullerian hormone; Premature ovarian insufficiency; Ovarian reserve
• ISSN: 1757-2215; 1757-2215
• DOI: 10.1186/s13048-019-0581-6

Breast cancer is the most common cancer in young women. Fortunately current survival rates of BC are significant which makes future fertility very important for quality of life of BC survivors. Chemotherapy carries a significant risk of infertility in BC patients so it is important to support fertility preservation decisions in premenopausal women. Amenorrhea has long been used as a surrogate marker of infertility in cancer patients but more reliable ovarian reserve (OR) markers are available. This study aimed to prospectively measure levels of OR in a cohort of young women with breast cancer exposed to chemotherapy, to identify adverse reproductive health outcomes in this population and to assess the influence of patient and treatment-related factors in those outcomes. This prospective observational study included premenopausal women with breast cancer aged 18-40 years at diagnosis and proposed for (neo) adjuvant chemotherapy. Patients were evaluated before, during and a minimum of 9 months after the end of chemotherapy. Reproductive health outcomes: menses, hormonal and ultrasound OR markers, recovery of ovarian function and Premature Ovarian Insufficiency (POI). A total of 38 patients were included (mean age 32.9 ± 3.5 years). Levels of OR significantly decreased during the study. At the last follow up, 35 patients had AMH below the expected values for age; eight presented postmenopausal FSH; ten had not recovered their ovarian function and five met the defined criteria for POI. Age and baseline AMH were positively correlated with AMH at the last follow-up. AMH levels were higher in the group of patients treated with trastuzumab and lower in those under hormonal therapy, at the last follow-up. Significant effects of systemic treatments on several reproductive outcomes and a strong relation of those outcomes with patient's age and baseline level of AMH were observed. Our results point to a possible lower gonadotoxicity when treatment includes targeted therapy with trastuzumab. Also, this investigation highlights the lack of reliable OR markers in women under hormonal therapy.