David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095-6900, USA.
J Natl Cancer Inst. 2012 Mar 7;104(5):386-405. doi: 10.1093/jnci/djr541. Epub 2012 Jan 23.
Breast cancer is the most common cancer in women younger than age 50 years. Cancer treatments in younger women may cause premature menopause, infertility, and negative psychosocial effects. In this systematic review, we examined three key domains of functioning that are particularly relevant for younger breast cancer survivors: health-related quality of life (QOL), menopausal symptoms and fertility concerns, and behavioral health outcomes.
We conducted a literature review using PubMed and secondary sources and examined 840 articles published between January 1990 and July 2010. Inclusion criteria for articles were 1) published in English after 1989; 2) exclusively analyzed female breast cancer survivors aged 50 years or younger or premenopausal at diagnosis, with baseline characteristics and/or quantitative or descriptive analyses for this age group; 3) investigated QOL (health-related QOL including physical functioning and mental health, depression, and anxiety), menopause- or fertility-related concerns, and weight gain or physical activity-related behavioral health outcomes. Data were extracted using a standardized table collecting the purpose, design, population, and results of each study. Extracted data were reviewed for accuracy by two investigators and presented as descriptive tables.
A total of 28 articles met the inclusion criteria (15 cross-sectional studies, eight longitudinal studies, and five randomized trials). Regarding data review, no discordance between investigators was noted. Standardized measures of QOL and depressive symptoms identified worse outcomes as being more frequent or severe in breast cancer survivors aged 50 years or younger when compared with the general age-matched population of women without cancer and to older women (aged >50 years) with breast cancer. Concerns about premature menopause, menopausal symptoms, and infertility were common in younger women (aged ≤ 50 years) and had a role in the level of distress after treatment. Weight gain and physical inactivity were common health outcomes in younger women.
Younger women with breast cancer were found to experience distinct psychosocial and menopause-related concerns, weight gain, and physical inactivity. A need for more longitudinal research, including efforts at intervention to manage these symptoms and adverse health outcomes, remains.
乳腺癌是 50 岁以下女性中最常见的癌症。年轻女性的癌症治疗可能导致过早绝经、不孕和负面的心理社会影响。在这项系统评价中，我们检查了三个对年轻乳腺癌幸存者特别相关的功能领域：健康相关生活质量（QOL）、绝经症状和生育问题以及行为健康结果。
我们使用 PubMed 和辅助资源进行了文献综述，并检查了 1990 年 1 月至 2010 年 7 月期间发表的 840 篇文章。纳入文章的标准为：1）1989 年后以英文发表；2）专门分析 50 岁或以下的女性乳腺癌幸存者或诊断时绝经前，具有该年龄组的基线特征和/或定量或描述性分析；3）调查 QOL（健康相关 QOL，包括身体功能和心理健康、抑郁和焦虑）、绝经或生育相关问题以及体重增加或与身体活动相关的行为健康结果。使用标准化表格收集每项研究的目的、设计、人群和结果，提取数据。由两名调查员对提取的数据进行准确性审查，并以描述性表格呈现。
共有 28 篇文章符合纳入标准（15 项横断面研究、8 项纵向研究和 5 项随机试验）。关于数据审查，两名调查员之间没有意见分歧。QOL 和抑郁症状的标准化测量表明，与无癌症的一般年龄匹配女性人群以及与年龄较大（>50 岁）的乳腺癌女性相比，50 岁或以下的乳腺癌幸存者更频繁或更严重地出现不良结局。年轻女性（≤50 岁）普遍存在绝经提前、绝经症状和不孕问题，这些问题在治疗后困扰程度中起重要作用。体重增加和身体活动不足是年轻女性常见的健康结果。
研究发现，年轻的乳腺癌女性经历了独特的心理社会和绝经相关问题、体重增加和身体活动不足。需要进行更多的纵向研究，包括努力进行干预以管理这些症状和不良健康结果。
