Association of tumor receptor status and treatment-induced amenorrhea in breast cancer survivors Open Access

Abstract

As survival for breast cancer has improved, concerns about the long-term side effects that may result from treatment, including amenorrhea and impaired fertility, have increased. Examining the association between estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status and treatment-induced amenorrhea may provide information clinicians can use when counseling premenopausal breast cancer patients treated with chemotherapy about possible effects of treatment on amenorrhea and fertility. This study included participants from the FUCHSIA Women's Study, which recruited female cancer survivors in Georgia who were diagnosed between the ages of 20-35 and who survived at least 2 years after diagnosis (median = 7 years; interquartile range, 5-11). Data were obtained through interview and medical records abstraction. Eligible women for this study included breast cancer survivors who were treated with chemotherapy. Among the 249 women in the final study population, 60.2% reported experiencing amenorrhea lasting six months or longer during treatment. The frequency of amenorrhea did not vary by ER or PR receptor status, but HER2 positive women were more likely to report amenorrhea than HER2 negative women (67.1% vs. 57.4%). After adjusting for confounders and cancer treatment, a possible intermediate between receptor status and amenorrhea, ER positive women were slightly less likely than ER negative women to report treatment-induced amenorrhea (aOR = 0.74; 95% CI, 0.23, 2.34), while the association between PR status and amenorrhea was null (aOR = 1.11; 95% CI, 0.43, 2.87). HER2 positive women were less likely to report treatment-induced amenorrhea than HER2 negative women after adjustment (aOR = 0.55; 95% CI, 0.23, 1.31). Treatment with Herceptin, commonly prescribed to HER2 positive women, was associated with an increased odds of amenorrhea (aOR = 3.92; 95% CI, 1.27-12.12). The value of knowing ER and PR receptor status was unclear. However, knowing HER2 status and whether Herceptin will be prescribed may help clinicians counsel premenopausal breast cancer patients on the potential effects of chemotherapy on amenorrhea and future fertility.

Table of Contents

Distribution Agreement

Approval Sheet

Abstract

Cover Page

Chapter 1: Background 1

Chapter 2: Introduction 12

Methods 14

Results 16

Discussion 21

References 24

Tables 32

Figures 40

Appendix A: Supplemental Tables 41

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Obstetrics and Gynecology Health Sciences, Oncology Health Sciences, Epidemiology
Keyword	estrogen receptor amenorrhea breast cancer chemotherapy premenopausal treatment-induced amenorrhea progesterone receptor HER2 receptor receptor status
Committee Chair / Thesis Advisor	Howards, Penelope, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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