Chemotherapy-Related Amenorrhea Common Among Younger Breast Cancer Survivors

Persistent chemotherapy-related amenorrhea (CRA) was common among premenopausal women who survived breast cancer, according to results of a prospective, longitudinal study published in JAMA Network Open.

No formal definition of CRA has been established but it has been reported to occur among 11% to 96% of young breast cancer survivors.

As the prevalence of CRA in breast cancer remains unclear, this study assessed CRA in breast cancer survivors using data from the Cancer Toxicities Study (CANTO). This study recruited 1636 women who were premenopausal at breast cancer diagnosis and received adjuvant and/or neoadjuvant chemotherapy. 

The outcomes of interest were CRA, based on patient-reported status and quality of life based on European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)–C30.

The women were mean age 42.2 (SD, 5.6) years at diagnosis, 59.9% had a normal BMI, 57.4% had stage II disease, 91.4% received combined anthracycline plus taxane, 94.4% underwent radiotherapy, and 75.1% received endocrine therapy.

Data on menses were available for 1497 women at year 1, 1323 women at year 2, and 906 women at year 4. CRA was reported by 83.0%, 72%, and 66.1% of the women at years 1, 2, and 4, respectively.

Increased risk for CRA associated with older age (adjusted odds ratio [aOR] for ages 45 and older, 21.29; 40 to 44, 5.90; and 35 to 39, 1.84) compared with 18 to 34 years, receipt of adjuvant tamoxifen (aOR, 1.97), presence of hot flashes at diagnosis (aOR, 1.83). 

Likelihood of CRA was lower in patients receiving anthracycline-based chemotherapy compared with anthracyclines plus taxanes (aOR, 0.35), those receiving taxane-based chemotherapy compared with anthracyclines plus taxanes (aOR, 0.53), and those receiving trastuzumab (aOR, 0.68).

Overall quality of life scores were similar between women who recovered menses by year 4 and those who did not recover menses (QLQ-C30 score mean difference [MD], −1.9 points). 

Women who did not recover menses by year 4 reported significantly more insomnia (MD, 9.9), worse sexual functioning (MD, −9.2), and more systemic therapy-related adverse effects (MD, 3.0) compared with women who regained menses.

“Proactive management of premenopausal women with early breast cancer undergoing chemotherapy should also include adapted strategies for risk communication, as well as personalized counseling and early supportive care referrals,” the study authors suggested in conclusion.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 

Reference

Kabirian R, Franzoi MA, Havas J, et al. Chemotherapy-related amenorrhea and quality of life among premenopausal women with breast cancer. JAMA Netw Open. 2023;6(11):e2343910. doi:10.1001/jamanetworkopen.2023.43910