Risk of chemotherapy-induced amenorrhea in patients with breast cancer: a systematic review and meta-analysis

Abstract

Background: The aim of the study was to calculate the rate of chemotherapy-induced amenorrhea (CIA) after treatment with different adjuvant therapies in patients with breast cancer and to evaluate the risk factors for CIA based on the quality of evidence. Patient and methods: A search of PubMed and ISI Web of Science was performed. All published trials with female breast cancer patients who received adjuvant chemotherapy and presented data on the rate of CIA were considered eligible. The pooled rates of CIA were calculated by random effects model. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each potential risk factor for CIA by using the generic inverse weighted method. Results: We identified 580 potentially relevant studies, of which 75 were included in the analysis. Among 75 eligible studies, 19 different definitions of CIA have been used. The pooled rate of CIA was 55% (95% CI 50-60%) including 23 673 patients from 74 studies. The rate of CIA was increased by age with an estimate of 26% (95% CI 12-43%), 39% (95% CI 31-58%), and 77% (95% CI 71-83%) for women <35, 35-40, and >40 years old, respectively. Two risk factors were associated with the occurrence of CIA and were supported by strong level of evidence: older age (>40 years old), and the use of tamoxifen. Conclusions: This meta-analysis summarized the updated evidence on the impact of different adjuvant treatment regimens for breast cancer in menstruation and could serve as a helpful guide for oncologists during the discussion with their patients on fertility issues before decision on adjuvant therapy is made. A uniform definition of CIA is essential in future studies to make the interpretation of results more reliable.

Chemotherapy Induced Amenorrhea in Women Treated with Chemotherapy for Breast Carcinoma in Yalgado Ou&#233;draogo Teaching Hospital in Ouagadougou, Burkina Faso

“…shown that women over 40 years were more likely to present a chemotherapy-induced amenorrhea than women under 40 years regardless of the type of treatment received [4] [11] [12]. This difference in risk was found in our study.…”

“…The definition of chemotherapy-induced amenorrhea varies depending on the study, constituting a limit to the comparison with different studies [10]. Indeed, some authors define the chemotherapy-induced amenorrhea in referring to the end of chemotherapy, while others consider a certain delay from the start of the chemotherapy [4]. We have retained the three-month period by referring to the definition of secondary amenorrhea, which is the absence of menses for more than three months in a woman who has normal menses previously [8].…”

“…Many studies have focused on chemotherapy-induced amenorrhea to assess the determinant factors. The main risk factors are age, chemotherapy protocols and cumulative doses [4] [5]. Other factors such as anthropometric parameters (weight, height), and lifestyle (smoking) were incriminated [6].…”

A Retrospective Study on the Onset of Menopause after Chemotherapy: Analysis of Data Extracted from the Jean Perrin Comprehensive Cancer Center Database Concerning 345 Young Breast Cancer Patients Diagnosed between 1994 and 2012

“…They demonstrated that 2 risk factors were associated with the occurrence of CIA supported by a strong level of evidence: older age (>40 years old) and the use of tamoxifen. As for the definition of CIM, Zavos and Valachis [28] explained that a uniform definition of CIA is essential in future studies to make the interpretation of results more reliable. Indeed in the 75 studies selected, 19 different definitions of CIA have been used.…”

“…In the literature, many studies were able to show that chemotherapy plus tamoxifen lead to an onset of amenorrhea but not to an onset of menopause. Zavos and Valachis [28] examined 75 relevant studies concerning CIA and the risk factors. They demonstrated that 2 risk factors were associated with the occurrence of CIA supported by a strong level of evidence: older age (>40 years old) and the use of tamoxifen.…”