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Incidence and time course of bleeding after long-term amenorrhea after breast cancer treatment
A prospective study
Article first published online: 9 APR 2010
Copyright © 2010 American Cancer Society
Volume 116, Issue 13, pages 3102–3111, 1 July 2010
How to Cite
Sukumvanich, P., Case, L. D., Van Zee, K., Singletary, S. E., Paskett, E. D., Petrek, J. A., Naftalis, E. and Naughton, M. J. (2010), Incidence and time course of bleeding after long-term amenorrhea after breast cancer treatment. Cancer, 116: 3102–3111. doi: 10.1002/cncr.25106
- Issue published online: 18 JUN 2010
- Article first published online: 9 APR 2010
- Manuscript Accepted: 29 JUL 2009
- Manuscript Revised: 13 JUL 2009
- Manuscript Received: 2 MAR 2009
- breast cancer;
- chemotherapy-induced amenorrhea;
The incidence of chemotherapy-induced amenorrhea (CIA) and the time to subsequent menstrual bleeding in premenopausal breast cancer patients treated with current standard chemotherapy regimens was examined.
Four hundred sixty-six women ages 20 to 45 years at the time of diagnosis of a stage I to III breast cancer were recruited between January 1998 and July 2002. Patients completed monthly bleeding calendars from the time of study recruitment. Updated medical history data were obtained at 6-month intervals.
Most women received doxorubicin and cyclophosphamide (AC); doxorubicin, cyclophosphamide, and paclitaxel (ACT); or cyclophosphamide, methotrexate, and 5-fluorouracil (CMF). Approximately 41% of women experienced an initial 6 months of CIA, and an additional 29% had at least 1 year of CIA. Approximately half of the women with 6 months of CIA and 29% of those with 1 year of CIA resumed bleeding within the subsequent 3 years, usually in the year after their amenorrheic episode. Resumption of bleeding differed significantly by treatment regimen after 6 months of CIA (P = .002; 68% with AC, 57% with ACT, and 23% with CMF), but not after 1 year of CIA (P = .5). Of the 23% of women who experienced an initial 2-year period of CIA, 10% resumed bleeding within the ensuing 3 years after their amenorrheic episode, but none had regular menses.
A considerable proportion of women treated with chemotherapy will experience periods of CIA, but many will resume bleeding. Newer treatment regimens such as ACT appear to have a higher resumption of bleeding compared with CMF. This finding may have implications for choice of anti-estrogen treatment and for future potential pregnancies/fertility. Cancer 2010. © 2010 American Cancer Society.