Originally published as JCO Early Release 10.1200/JCO.2006.07.2793 on November 27 2006

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Amenorrhea in Premenopausal Women After Adjuvant Chemotherapy for Breast Cancer

Janice M. Walshe, Neelima Denduluri, Sandra M. Swain

From the Breast Cancer Section, Medical Oncology Branch, Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, MD

Address reprint requests to Sandra M. Swain, MD, Breast Cancer Section, Medical Oncology Branch, Centre for Cancer Research, National Cancer Institute, National Institute of Health, 8901 Wisconsin Ave, Building 8, Room 5101, Bethesda, MD 20889; e-mail: swains{at}mail.nih.gov

Chemotherapy and ovarian ablation both independently improve survival in premenopausal women with hormone-sensitive breast cancer. Amenorrhea is a well-recognized occurrence after chemotherapy. The rate of chemotherapy-induced amenorrhea varies with patient age and chemotherapy regimens administered. However, the impact of chemotherapy-induced amenorrhea on prognosis is still being defined. Older studies in premenopausal women argue that the benefit with chemotherapy is a result of direct cytotoxicity alone. However, studies that restrict outcome analysis to hormone receptor–positive tumors suggest that chemotherapy has a dual mechanism in women with hormone-responsive tumors; indirect endocrine manipulation secondary to chemotherapy-induced ovarian suppression and direct cytotoxicity. The significant health ramifications involved with the induction of premature menopause as well as potential benefits necessitate a comprehensive evaluation of chemotherapy-induced amenorrhea. This review will discuss the incidence of amenorrhea with commonly-used adjuvant chemotherapeutic regimens, the possible benefits of chemotherapy-induced amenorrhea, and the challenges of interpreting the existing data in breast cancer trials.

published online ahead of print at www.jco.org on November 27, 2006.

Supported by the Intramural Research Program of the Center for Cancer Research, National Cancer Institute, National Institutes of Health.

J.M.W. and N.D. contributed equally to this work.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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