OVARIAN-FUNCTION IN PREMENOPAUSAL WOMEN TREATED WITH ADJUVANT CHEMOTHERAPY FOR BREAST-CANCER

Purpose: Adjuvant chemotherapy for breast cancer causes significant ch anges in ovarian function, More young women survive breast cancer than ever before and they are at risk of the sequelae of early menopause. We attempted to (1) define menopausal status in the setting of adjuvan t chemotherapy; (2) define chemotherapy-related amenorrhea (CRA); (3) document rates of permanent amenorrhea, temporary amenorrhea, and olig omenorrhea among different regimens; and (4) analyze variables that in fluence ovarian function. Design: We reviewed reports of the effects o f adjuvant chemotherapy for breast cancer on ovarian function in preme nopausal women, We searched Medline and Cancerlit from 1966 to 1995 on the following terms: breast neoplasms; chemotherapy, adjuvant; menstr uation disorders; premature menopause; and amenorrhea, Further referen ces were obtained from reports retrieved in the initial search. Result s: A uniform definition of menopause and CRA is lacking. The wide rang e of CRA rates reported in adjuvant chemotherapy trials is a result, a t least in part, of this problem. The average CRA rate reported in reg imens based on cyclophosphamide, methotrexate, and fluorouracil (CMF) is 68% (95% confidence interval [CI], 66% to 70%), with a range of 20% to 100%, CRA incidence varies with age, cytotoxic agent, and cumulati ve dose. Conclusion: Ovarian damage is the most significant long-term sequela of adjuvant chemotherapy in premenopausal breast cancer surviv ors, We suggest a common definition of the following important terms: menopausal status, CRA (early and late), temporary CRA, and oligomenor rhea in the setting of adjuvant treatment. With uniform definitions in place, regimens can be more precisely compared with respect to this i mportant complication. (C) 1996 by American Society of Clinical Oncolo gy.