Impact of tamoxifen therapy on fertility in breast cancer survivors

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.

Ovarian hyperstimulation closely associated with resumption of follicular growth after chemotherapy during tamoxifen treatment in premenopausal women with breast cancer: a multicenter retrospective cohort study

“…The relationship of the incidence of high estrogenic condition and risk for relapse of breast cancer should be investigated in the future. Additionally, it was recently reported that breast cancer survivors treated with tamoxifen showed low rate of having a child compared with the tamoxifen nonusers [22]. This study also demonstrated that ovarian reserve rates in the tamoxifen users were higher than those in the tamoxifen nonusers, suggesting the presence of non-ovarian factors to induce the adverse effects on fertility by TAM treatment.…”

Fertility in female cancer survivors: a systematic review and meta-analysis

“…After review of the titles and abstracts, 41 studies were identified as potentially eligible for inclusion. After full review, four systematic reviews were excluded (Levine et al, 2015;Lopategui et al, 2017;van Dorp et al, 2016;Burkart et al, 2019), one publication because data could not be extracted (Zynda et al, 2012), 15 original studies because of the absence of a healthy control group (Carter et al, 2006;Kiserud et al, 2007;Sudour et al, 2010;Speiser et al, 2011;Hamre et al, 2012;Hansen et al, 2013;Reinmuth et al, 2013;Shepherd et al, 2006;Greaves et al, 2014;Naessén et al, 2014;Hoshi et al, 2015;Wu et al, 2015;Yonemoto et al, 2016;Shandley et al, 2017;Nichols et al, 2018) and three additional studies because they generically referred to reproductive prognosis after cancer without splitting data for cancer subtypes (Green et al, 2009;Reulen et al, 2009;Dillon et al, 2013).…”

Long-Term and Latent Side Effects of Specific Cancer Types

“…38 Approximately 10% of BC survivors older than 45 experience chemotherapy-induced menopause, and tamoxifen use is associated with decreased fertility among premenopausal cancer survivors. 39,40 Menopausal symptoms such vasomotor hot flashes are observed among 50–70% of tamoxifen users. Symptoms are often more severe in younger patients due to the abrupt change in hormonal status.…”