Adriana Valentini, Amy Finch, Ping Sun, and Steven A. Narod, Women's College Research Institute; Ellen Greenblatt, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto; Peter J. Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, Research Center of the University of Montreal Hospital Centre, Montreal, Quebec; Charmaine Kim-Sing, BC Cancer Agency, Vancouver, British Columbia, Canada; Henry T. Lynch, Creighton University School of Medicine, Omaha, NE; Susan L. Neuhausen, Beckman Research Institute, City of Hope, Duarte, CA; Jan Lubiński and Tomasz Byrski, Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; and Christian Singer, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
J Clin Oncol. 2013 Nov 1;31(31):3914-9. doi: 10.1200/JCO.2012.47.7893. Epub 2013 Aug 26.
To determine the likelihood of long-term amenorrhea after treatment with chemotherapy in women with breast cancer who carry a BRCA1 or BRCA2 mutation.
We conducted a multicenter survey of 1,954 young women with a BRCA1 or BRCA2 mutation who were treated for breast cancer. We included premenopausal women who were diagnosed with invasive breast cancer between 26 and 47 years of age. We determined the age of onset of amenorrhea after breast cancer for women who were and were not treated with chemotherapy, alone or with tamoxifen. We considered chemotherapy-induced amenorrhea to have occurred when the patient experienced ≥ 2 years of amenorrhea, commencing within 2 years of initiating chemotherapy, with no resumption of menses.
Of the 1,426 women who received chemotherapy, 35% experienced long-term amenorrhea. Of the 528 women who did not receive chemotherapy, 5.3% developed long-term amenorrhea. The probabilities of chemotherapy-induced amenorrhea were 7.2% for women diagnosed before age 30 years, 33% for women age 31 to 44 years, and 79% for women diagnosed after age 45 years (P trend < .001). The probability of induced amenorrhea was higher for women who received tamoxifen than for those who did not (52% v 29%; P < .001).
Age at treatment and use of tamoxifen are important predictors of chemotherapy-induced amenorrhea in women who carry a BRCA1 or BRCA2 mutation. The risk of induced long-term amenorrhea does not seem to be greater among mutation carriers than among women who do not carry a mutation.
确定携带 BRCA1 或 BRCA2 突变的乳腺癌女性接受化疗后长期闭经的可能性。
我们对 1954 名接受乳腺癌治疗的携带 BRCA1 或 BRCA2 突变的年轻女性进行了多中心调查。我们纳入了诊断为 26 至 47 岁之间侵袭性乳腺癌的绝经前女性。我们确定了未接受化疗、单独接受化疗或接受他莫昔芬治疗的女性乳腺癌后闭经的发病年龄。我们认为化疗引起的闭经是指患者在开始化疗后 2 年内经历了≥ 2 年的闭经，且没有月经恢复。
在接受化疗的 1426 名女性中，35%出现长期闭经。在未接受化疗的 528 名女性中，5.3%出现长期闭经。诊断年龄<30 岁的女性发生化疗引起的闭经的概率为 7.2%，诊断年龄 31 至 44 岁的女性为 33%，诊断年龄>45 岁的女性为 79%（趋势 P<0.001）。接受他莫昔芬治疗的女性发生诱导性闭经的概率高于未接受他莫昔芬治疗的女性（52%比 29%；P<0.001）。
治疗时的年龄和是否使用他莫昔芬是携带 BRCA1 或 BRCA2 突变的女性化疗引起闭经的重要预测因素。诱导性长期闭经的风险似乎在突变携带者中并不高于未携带者。
