Abstract
Background: Worldwide, breast cancer (BC) is the most common malignancy in the female population. In recent years, its diagnosis in young women has increased, together with a growing desire to become pregnant later in life. Although there is evidence about the detrimental effect of chemotherapy (CT) on the menses cycle, a practical tool to measure ovarian reserve is still missing. Recently, anti-Mullerian hormone (AMH) has been considered a good surrogate for ovarian reserve. The main objective of this paper is to evaluate the effect of CT on AMH value. Methods: A systematic review and meta-analysis were conducted on the PubMed and Scopus electronic databases on articles retrieved from inception until February 2021. Trials evaluating ovarian reserves before and after CT in BC were included. We excluded case reports, case-series with fewer than ten patients, reviews (narrative or systematic), communications and perspectives. Studies in languages other than English or with polycystic ovarian syndrome (PCOS) patients were also excluded. AMH reduction was the main endpoint. Egger’s and Begg’s tests were used to assess the risk of publication bias. Results: Eighteen trials were included from the 833 examined. A statistically significant decline in serum AMH concentration was found after CT, persisting even after years, with an overall reduction of −1.97 (95% CI: −3.12, −0.82). No significant differences in ovarian reserve loss were found in the BRCA1/2 mutation carriers compared to wild-type patients. Conclusions: Although this study has some limitations, including publication bias, failure to stratify the results by some important factors and low to medium quality of the studies included, this metanalysis demonstrates that the level of AMH markedly falls after CT in BC patients, corresponding to a reduction in ovarian reserve. These findings should be routinely discussed during oncofertility counseling and used to guide fertility preservation choices in young women before starting treatment.
Highlights
Breast cancer (BC) is the most common cancer in the female population, with an estimated 2.3 million new cases worldwide in 2020 [1].While the death rate has dropped by 40% since 1989, an increase in breast cancer (BC) among young women has been reported, with around 10% of new cases diagnosed in patients younger than 40 years old [2].Physicians should carry out counseling on fertility issues and fertility preservation in patients who have not completed childbearing before starting treatment [3].Recent evidence has shown that age and the use of cyclophosphamide-based chemotherapy are the main factors influencing ovarian failure
A growing body of literature has been published on the effect of chemotherapy on the ovarian reserve in women with BC, assessed by anti-Mullerian hormone (AMH) [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25]
This paper is the first systematic review and meta-analysis to evaluate the effect of chemotherapy on AMH in BC patients
Summary
Breast cancer (BC) is the most common cancer in the female population, with an estimated 2.3 million new cases worldwide in 2020 [1].While the death rate has dropped by 40% since 1989, an increase in BC among young women has been reported, with around 10% of new cases diagnosed in patients younger than 40 years old [2].Physicians should carry out counseling on fertility issues and fertility preservation in patients who have not completed childbearing before starting treatment [3].Recent evidence has shown that age and the use of cyclophosphamide-based chemotherapy are the main factors influencing ovarian failure. While the death rate has dropped by 40% since 1989, an increase in BC among young women has been reported, with around 10% of new cases diagnosed in patients younger than 40 years old [2]. A growing body of literature has been published on the effect of chemotherapy on the ovarian reserve in women with BC, assessed by AMH [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25]. Anti-Mullerian hormone (AMH) has been considered a good surrogate for ovarian reserve.
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