Impact of tamoxifen therapy on fertility in breast cancer survivors Open Access
Shandley, Lisa Maureen (2017)
Abstract
Objective: To determine if tamoxifen use is associated with decreased ovarian reserve and decreased likelihood of having a child following breast cancer diagnosis.
Design: Furthering Understanding of Cancer, Health, and Survivorship in Adult (FUCHSIA) Women Study-a population-based cohort study
Setting: Not applicable.
Patients: Three hundred ninety-seven female breast cancer survivors aged 22-45 years who were diagnosed between ages 20-35 years and were at least 2 years post-diagnosis; 108 survivors also participated in a clinic visit.
Intervention(s): None
Main Outcome Measure(s): Time to first child after cancer
diagnosis, clinical measures of ovarian reserve
(anti-Müllerian hormone [AMH] and antral follicle count [AFC])
after cancer
Results: Women who ever used tamoxifen were substantially less likely to have a child following breast cancer diagnosis (hazard ratio [HR]=0.29, 95% confidence interval [CI]: 0.16, 0.54) than women who had never used tamoxifen. After adjusting for age at diagnosis, exposure to an alkylating agent, and race, the HR was 0.25 (95% CI: 0.14, 0.47). However, after adjusting for potential confounders, women who had used tamoxifen had an estimated geometric mean AMH level 2.47 (95% CI: 1.08, 5.65) times higher than women who had never taken tamoxifen. AFC was also higher in the tamoxifen group compared to tamoxifen non-users when adjusted for the same variables (risk ratio=1.21, 95% CI: 0.84, 1.73).
Conclusion: Breast cancer survivors who used tamoxifen
were less likely to have a child following cancer diagnosis
compared to survivors who never used tamoxifen. However, tamoxifen
users did not have decreased ovarian reserve compared to tamoxifen
non-users.
Table of Contents
Table of Contents
Introduction...........................................................................................p. 1
Methods................................................................................................p. 3
Study Population............................................................................p. 3
Procedures....................................................................................p. 3
Statistical Analysis.........................................................................p. 5
Results.................................................................................................p. 8
Descriptive Statistics......................................................................p. 8
Time to First Child after Diagnosis....................................................p. 9
Clinical Markers of Ovarian Reserve..................................................p. 10
Discussion.............................................................................................p. 13
References............................................................................................p. 18
Tables..................................................................................................p. 23
Table 1. Demographic and cancer characteristics of breast
cancer survivors who participated in the telephone interview
and who had not had a hysterectomy or bilateral
oophorectomy prior to cancer diagnosis, 2012-2013..........................p. 23
Table 2. Unadjusted hazard ratios for analysis of the
association between tamoxifen and having a child after
cancer diagnosis, 2012-2013... .......... .......... .......... ....................... ..p. 26
Table 3. Adjusted hazard ratios for analysis of the
association between tamoxifen and having a child after
cancer diagnosis, 2012-2013... .......... .......... .......... ............. ............p. 28
Table 4. Demographic and cancer characteristics of breast
cancer survivors who participated in the telephone interview
(2012-2013) and came to clinic (2013-2015)....................................p. 30
Table 5. Estimates for the predicted geometric mean value
of anti-Müllerian hormone (AMH) and the predicted mean
antral follicle count (AFC) comparing breast cancer survivors
who took tamoxifen to survivors who did not take tamoxifen..............p. 33
Table 6. Estimates for the predicted geometric mean value of
anti- Müllerian hormone (AMH) and the predicted mean antral
follicle count (AFC) comparing breast cancer survivors who
have a history of taking tamoxifen but are not actively taking
it to survivors who have never taken tamoxifen................................p. 34
Figures................................................................................................p. 35
Figure 1. Unadjusted Kaplan-Meier curves of time to first
child following breast cancer diagnosis by tamoxifen status................p. 35
Supplemental Materials.........................................................................p. 39
Supplemental Appendix. Additional information on supplemental
analysis for time to first child following breast cancer where
timeat risk began when the survivor finished breast cancer
treatmentor tamoxifen use............................................................p. 39
Supplemental Figure 1. Unadjusted Kaplan-Meier curve of time
to first child following breast cancer treatment by tamoxifen
status.........................................................................................p. 40
About this Master's Thesis
| School | |
|---|---|
| Department | |
| Degree | |
| Submission | |
| Language |
|
| Research Field | |
| Keyword | |
| Committee Chair / Thesis Advisor | |
| Committee Members |
Primary PDF
| Thumbnail | Title | Date Uploaded | Actions |
|---|---|---|---|
|
|
Impact of tamoxifen therapy on fertility in breast cancer survivors () | 2018-08-28 10:54:28 -0400 |
|
Supplemental Files
| Thumbnail | Title | Date Uploaded | Actions |
|---|