Abstract
IntroductionHormone replacement therapy can diminish hormone depletion-related complaints in postmenopausal women, but is contraindicated for postmenopausal breast cancer (BC) patients. Recovery of menstruation after chemotherapy-induced amenorrhea in young hormone receptor-negative BC patients however, is accepted. To determine the safety of this strategy, we investigated the effect of recovery of menstruation on disease-free survival (DFS) and overall survival (OS) in young hormone receptor-negative BC patients treated with (neo)adjuvant chemotherapy. MethodsWe selected 636 patients from a single-center cohort with early stage hormone receptor-negative BC and under the age of 50 years when treated with chemotherapy. Sufficient data on course of menstruation in medical records was retrospectively found for 397 patients, of whom 299 patients (75%) had a recovery of menstruation after chemotherapy. We used Cox proportional hazards models to estimate hazard ratios (HR) for the effect of recovery of menstruation on DFS and OS. ResultsPatients with recovery of menstruation after chemotherapy less frequently had lymph node involvement at diagnosis (45% vs 66%, p = 0.001). After a median follow-up of 6.7 years, the adjusted hazard ratios were 1.45 (95% CI: 0.83–2.54) for DFS and 1.19 (95% CI: 0.71–1.98) for OS. ConclusionNo significantly increased recurrence risk was found for hormone receptor-negative BC patients with recovery of menstruation after chemotherapy. However, the outcome of the multivariable model is not reassuring and a potentially increased recurrence risk cannot be excluded. The results need to be validated in a larger prospective study for a more definitive answer.
Highlights
Hormone replacement therapy can diminish hormone depletion-related complaints in postmenopausal women, but is contraindicated for postmenopausal breast cancer (BC) patients
Since the safety of accepting natural recovery of ovarian function in young hormone receptor-negative BC patients treated withadjuvant chemotherapy is unclear, we investigated the effect of recovery of menstruation on disease-free survival (DFS) and overall survival (OS) in this patient population
Patients with recovery of menstruation after chemotherapy were younger at BC diagnosis than patients without recovery of menstruation, were more often without lymph node involvement (55% vs 34%, p 1⁄4 0.001), and were less often treated with endocrine therapy (3% versus 13%, p < 0.001)
Summary
Despite having a reputation of being a disease of the elderly, cancer burden in young adults is quite substantial [1]. M. van Barele et al / The Breast 52 (2020) 102e109 on menopausal complaints and showed that HRT led to a decrease in hormone depletion-related symptoms [9] Though, both studies were terminated prematurely because interim analyses showed an increased risk of BC recurrence in the HRT group [9,10]. Subgroup analyses for estrogen receptor (ER)negative BC patients showed no significantly increased risk of BC recurrence when treated with HRT (HR 1.9, 95% CI 0.4e9.6 [10] and HR 1.15, 95% CI 0.73e1.80 [9]) These analyses were done post-hoc, with relatively small subgroups [10] and no data regarding potentially confounding factors were provided [9]. Since the safety of accepting natural recovery of ovarian function in young hormone receptor-negative BC patients treated with (neo)adjuvant chemotherapy is unclear, we investigated the effect of recovery of menstruation on disease-free survival (DFS) and overall survival (OS) in this patient population
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