This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Naughton, M. J. Articles by Sukumvanich, P. Search for Related Content PubMed Articles by Naughton, M. J. Articles by Sukumvanich, P.

In Reply

Division of Public Health Sciences, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC

Paniti Sukumvanich

Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Pittsburgh, Pittsburgh, PA

We have read with interest the correspondence regarding the use of hormone markers of endocrine reserve and functioning,¹ generated by our published report of the menstrual cycle maintenance of a large cohort of premenopausal women after breast cancer treatment.² We concur with both Oktay and colleagues¹ and Anderson and Cameron that reliable and valid hormonal markers of ovarian functioning and reserve, in addition to patients’ prospective reports of menstrual bleeding, would provide very useful information about the impact of chemotherapy regimens on ovarian functioning.

The data reported by Petrek et al² are from a large prospective study of premenopausal breast cancer patients. The initial grant that funded this study was awarded in 1996. The majority of our study cohort was recruited between 1998 and the end of 2000, before much of the published research on the potential value of newer hormonal markers, such as anti-Mullerian hormone,³ to assess ovarian functioning and reserve. As has been stated previously, estradiol and follicular stimulating hormone, some of the most commonly assessed measures of ovarian function in the 1990s, are not always reliable indicators of ovarian functioning after breast cancer treatment.⁴ Thus, only patient diaries were used in our study. This coupled with the longitudinal nature of our study in observing patients long past standard treatment, and the geographical breadth of our patient population, would have also made the collection of hormonal markers extremely difficult.

Although we agree that menstrual bleeding diaries do not provide a complete picture of what is transpiring in the ovaries after chemotherapy treatment, we still maintain that menstrual bleeding is a strong indicator of the presence of ovarian functioning and can provide us with valuable information to assist patients and their physicians in making clinical decisions regarding treatment options. We have several papers forthcoming which examine the reinitiation of menses 6 months, 1 year, and 2 years of amenorrhea after treatment; pregnancy outcomes among those survivors who were able to become pregnant after chemotherapy; and the impact of treatment on the health-related quality of life of women during the first 5 years after diagnosis. We are now entering our ninth year of follow-up with our earliest recruited patients, and have plans to continue to observe the cohort for at least 10 years post-treatment. Prospective, long-term studies are imperative in order to assess the impact of breast cancer treatment on patients’ physical, emotional, and reproductive health. We welcome any such efforts in this area.

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Although all authors completed the disclosure declaration, the following authors or their immediate family members indicated a financial interest. No conflict exists for drugs or devices used in a study if they are not being evaluated as part of the investigation. For a detailed description of the disclosure categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors.

Employment: N/A Leadership: N/A Consultant: N/A Stock: N/A Honoraria: Paniti Sukumvanich, Eli Lilly Research Funds: Michelle J. Naughton, U.S. Army Research & Materiel Command; Paniti Sukumvanich, Private donor funding Testimony: N/A Other: N/A

ACKNOWLEDGMENTS

The study findings discussed herein were funded by the U.S Army Medical Research and Materiel Command under DAMD17-96-1-6292 and DAMD17-01-1-0447.

REFERENCES

1. Oktay K, Oktem O, Reh A, et al: Measuring the impact of chemotherapy on fertility in women with breast cancer. J Clin Oncol 24:4044-4046, 2006[Free Full Text]

2. Petrek JA, Naughton MJ, Case LD, et al: Incidence, time course, and determinants of menstrual bleeding after breast cancer treatment: A prospective study. J Clin Oncol 24:1045-1051, 2006[Abstract/Free Full Text]

3. van Rooij IAJ, Broekmans FJM, Scheffer GJ, et al: Serum antimullerian hormone levels best reflect the reproductive decline with age in normal women with prove fertility: A longitudinal study. Fertil Steril 83:979-987, 2005[CrossRef][Medline]

4. Braverman AS, Sawhney H, Tendler A, et al: Pre-menopausal serum estradiol (E₂) levels may persist after chemotherapy (CT) induced amenorrhea in breast cancer (BC). Proc Am Soc Clin Oncol 21:42s, 2002 (abstr 164)

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Naughton, M. J. Articles by Sukumvanich, P. Search for Related Content PubMed Articles by Naughton, M. J. Articles by Sukumvanich, P.