Originally published as JCO Early Release 10.1200/JCO.2005.03.3969 on February 13 2006
Journal of Clinical Oncology, Vol 24, No 7 (March 1), 2006: pp. 1045-1051
© 2006 American Society of Clinical Oncology.
Incidence, Time Course, and Determinants of Menstrual Bleeding After Breast Cancer Treatment: A Prospective Study
Jeanne A. Petrek ,
Michelle J. Naughton,
L. Douglas Case,
Electra D. Paskett,
Elizabeth Z. Naftalis,
S. Eva Singletary,
Paniti Sukumvanich
From the Memorial Sloan-Kettering Cancer Center, New York, NY; Wake Forest University School of Medicine, Winston-Salem, NC; Ohio State University, Columbus, OH; University of Texas-Southwestern, Dallas; The University of Texas M.D. Anderson Cancer Center, Houston, TX; University of Pittsburgh, Pittsburgh, PA
Jeanne A. Petrek, MD, died on April 11, 2005, during final preparations of this article.
Address reprint requests to Michelle J. Naughton, PhD, Department of Public Health Sciences, Wake Forest University School of Medicine, 2000 W First St, Rm 224, Winston-Salem, NC 27104; e-mail: naughton{at}wfubmc.edu
PURPOSE: To assess ovarian function using the surrogate of monthly bleeding after breast cancer treatment in premenopausal women.
PATIENTS AND METHODS: Five hundred ninety-five US women age 20 to 45 years were accrued from January 1998 to July 2002 within 8 months of diagnosis with stages I to III breast cancer (median follow-up 45 months). Daily bleeding records were obtained prospectively, as well as extensive clinical, demographic, quality of life, and treatment data. Repeated measures logistic regression was used to assess which variables were predictive of monthly bleeding.
RESULTS: Significantly different proportions of women had monthly bleeding depending on their age (P < .001), chemotherapy program (P < .001), and time since treatment regimen. In the month after the standard course of doxorubicin and cyclophosphamide (AC), whether or not followed by paclitaxel or docetaxel, approximately 16% had monthly bleeding compared with the cyclophosphamide, methotrexate, fluorouracil (CMF) group, in which 48% bled (P < .001). Following any AC regimen, there was a slow recovery phase of about 9 months followed by a plateau, during which almost half continued monthly bleeding for the remainder of the follow-up period compared with after CMF in which there was no recovery phase and a continual decline in monthly bleeding to approximately 18% of women at study end (P < .001). Tamoxifen use decreased bleeding between months 12 and 24 after chemotherapy with 15% fewer women having bleeding.
CONCLUSION: Using daily menstrual bleeding records, it is demonstrated that age, the specific chemotherapy regimen received, and tamoxifen use impact ovarian function.
Supported by research funded by the US Army Medical Research and Materiel Command under DAMD17-96-1-6292 and DAMD17-01-1-0447.
Presented in part at the 41st Annual Meeting of the American Society of Clinical Oncology, Orlando, FL, May 13-17, 2005 and at the Fourth Era of Hope: Department of Defense Breast Cancer Research Program Meeting, Philadelphia, PA, June 8-11, 2005.
Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.
Related Correspondence
- Assessment of the Effect of Chemotherapy on Ovarian Function in Women With Breast Cancer
Richard A. Anderson and David A. Cameron
JCO 2007 25: 1630-1631
[Full Text]
This article has been cited by other articles:
|
|
|
|
 
A. A. Azim, M. Costantini-Ferrando, and K. Oktay
Safety of Fertility Preservation by Ovarian Stimulation With Letrozole and Gonadotropins in Patients With Breast Cancer: A Prospective Controlled Study
J. Clin. Oncol.,
June 1, 2008;
26(16):
2630 - 2635.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Parton and I. E. Smith
Controversies in the Management of Patients With Breast Cancer: Adjuvant Endocrine Therapy in Premenopausal Women
J. Clin. Oncol.,
February 10, 2008;
26(5):
745 - 752.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. R. Schover
Premature Ovarian Failure and Its Consequences: Vasomotor Symptoms, Sexuality, and Fertility
J. Clin. Oncol.,
February 10, 2008;
26(5):
753 - 758.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. H. Partridge
Fertility Preservation Considerations in Young Women with Breast Cancer
ASCO Educational Book,
January 1, 2008;
2008(1):
36 - 38.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Duffy, K. Perez, and A. Partridge
Implications of Phytoestrogen Intake for Breast Cancer
CA Cancer J Clin,
September 1, 2007;
57(5):
260 - 277.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. C. F. Moore and R. L. Theriault
Commentary: Ovarian Function Does Not Equal Fertility Does Not Equal Babies
Oncologist,
September 1, 2007;
12(9):
1067 - 1069.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J.E. Mourits, E. G.E. de Vries, K. A. ten Hoor, A. G.J. van der Zee, and P. H.B. Willemse
Beware of Amenorrhea During Tamoxifen: It May Be a Wolf in Sheep's Clothing
J. Clin. Oncol.,
August 20, 2007;
25(24):
3787 - 3788.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. A. Anderson and D. A. Cameron
Assessment of the Effect of Chemotherapy on Ovarian Function in Women With Breast Cancer
J. Clin. Oncol.,
April 20, 2007;
25(12):
1630 - 1631.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Naughton and P. Sukumvanich
In Reply
J. Clin. Oncol.,
April 20, 2007;
25(12):
1632 - 1632.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. D. Paskett, M. J. Naughton, T. P. McCoy, L. D. Case, and J. M. Abbott
The Epidemiology of Arm and Hand Swelling in Premenopausal Breast Cancer Survivors
Cancer Epidemiol. Biomarkers Prev.,
April 1, 2007;
16(4):
775 - 782.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Walshe, N. Denduluri, and S. M. Swain
Amenorrhea in Premenopausal Women After Adjuvant Chemotherapy for Breast Cancer
J. Clin. Oncol.,
December 20, 2006;
24(36):
5769 - 5779.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S Aebi and M Castiglione
The enigma of young age.
Ann. Onc.,
October 1, 2006;
17(10):
1475 - 1477.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Oktay, O. Oktem, A. Reh, and L. Vahdat
Measuring the Impact of Chemotherapy on Fertility in Women With Breast Cancer
J. Clin. Oncol.,
August 20, 2006;
24(24):
4044 - 4046.
[Full Text]
[PDF]
|
|
|
|
