<p>Controversies Regarding Ovarian Suppression and Infertility in Early Stage Breast Cancer</p>

Abstract

A common side effect of chemotherapy in breast cancer is early menopause in premenopausal patients, which is mainly a result of an indirect form of ovarian ablation, and is associated with substantial impairment of quality of life. Suppressing the production of ovarian estrogen has been shown to reduce the recurrence of hormone receptor-positive early breast cancer in premenopausal women, but whether it has an added advantage over tamoxifen is being discussed. Types of permanent ablation of the ovarian function include surgical oophorectomy and radiation-induced ovarian failure. Both are associated with similar response rates in hormone receptor-positive metastatic breast cancer. Medical castration with luteinizing hormone-releasing hormone analogs (LHRHa) has the benefit of being a reversible approach. Another advantage that premenopausal patients who wish to reduce the risk of developing premature ovarian insufficiency induced by chemotherapy may be offered LHRHa irrespective of whether they desire pregnancy and their age at diagnosis. This also helps reduce the risk of menopausal signs and symptoms as well as the loss of bone density in the long-term, which are primary concerns for women. This is of utmost importance to premenopausal women who do not want to conceive after treatment or are not candidates for fertility preservation strategies because of age. It should be emphasized that for women who are interested in fertility preservation, gamete cryopreservation remains the first option, and LHRHa is not an alternative. During chemotherapy, however, temporary ovarian suppression with LHRHa may be given to women who either have no access to a fertility clinic or who have declined chemotherapy or have contraindications.

Neuropsychiatric effects of tamoxifen: Challenges and opportunities

“…The lack of beneficial effects of tamoxifen on cognition in postmenopausal women may be due to the intact low levels of estradiol compared to ovariectomized animals (Koebele and Bimonte-Nelson, 2016), which result in tamoxifen acting as an antiestrogen rather than estrogen mimetic. Alternatively, tamoxifen in postmenopausal women may be similar to the effects seen with hormone replacement therapy that is initiated "outside the window" of time for potential benefit, and this may be exacerbated by the fact that breast cancer therapies on their own may induce premature menopause (Durrani and Heena, 2020). In order to better clarify tamoxifen's varied effects, future studies in animals and humans could utilize a combined dose-response strategy in which various doses of tamoxifen are studied alongside various doses of estradiol.…”

Integrating Data Analytics and Decision Support Systems in Public Health Management

“…• Real-Time Monitoring: Data analytics enables [16] public health agencies to monitor health-related data in real time, including electronic health records, syndromic surveillance systems, and social media feeds. By analyzing these data sources, decision-makers can detect early warning signs of disease outbreaks, track the spread of infectious diseases, and identify high-risk populations and geographical areas.…”

Identification of key genes controlling docetaxel resistance in patients with breast cancer

“…Although the early diagnosis, early treatment and individualized treatment have significantly reduced the mortality rate of breast cancer, its mortality rate still ranks among the highest female malignant tumors. Surgical resection is the radical treatment of breast cancer, but with the deepening of the understanding of breast cancer disease, the treatment of breast cancer patients has shifted from simple surgery to a holistic treatment combining surgery, chemotherapy, radiotherapy, targeted therapy and endocrine therapy [2][3][4][5]. Docetaxel is a kind of commonly used drugs in the chemotherapy for breast cancer, an M phase cell cycle specific drug, can promote tubular polymerization stability of microtubules, and suppress the depolymerization, leading to significantly reduction of small tube number and inhibition of cell proliferation.…”

“…The higher expression level indicated the better prognosis.DiscussionBreast cancer is the most common malignant tumor in women, accounting for about 24.2% of malignant tumors in women[1]. At present, the treatment of breast cancer patients has been a comprehensive treatment integrating surgery, chemotherapy, radiotherapy, targeted therapy, endocrine therapy and other treatment methods[2, 4, 16]. According to the immunohistochemical characteristics, it was clinically divided into Luminal A subtype, Luminal B subtype, HER-2 overexpression subtype and Basal-like subtype/triple negative breast cancer[17].…”