Impact of tamoxifen therapy on fertility in breast cancer survivors Open Access

Shandley, Lisa Maureen (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/4q77fr55n?locale=en
Published

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

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