ESMO 2022 - Three-quarters of women aged less than 40 treated by chemotherapy for localised breast cancer re-establish their menstrual cycles

11th September 2022

ESMO 2022

Three-quarters of women aged less than 40 treated by chemotherapy for localised breast cancer re-establish their menstrual cycles

Around 83% of non-menopausal women treated for localised breast cancer have amenorrhoea a year after diagnosis. By contrast, 4 years after diagnosis, 74% of patients aged less than 40 have re-established their menstrual cycles. This is one of the conclusions of the prospective longitudinal study derived from the CANTO cohort, presented at the ESMO Congress. It examined the factors linked to the absence of periods and analysed its effects on the quality of life. The results also show that amenorrhoea lasting longer than 4 years from diagnosis has a negative impact on sexual health and cognitive function and gives rise to more side effects of chemotherapy.   

Study presented Sunday 11th September at 8.30 am at an oral session of the ESMO (European Society for Medical Oncology) Congress by Dr Rayan Kabirian, gynaecologist at Gustave Roussy.

Breast cancer is one of the commonest cancers seen in premenopausal women. Chemotherapy prior to or following surgery may induce transient or permanent amenorrhoea (periods absent for more than 6 months). The prospective longitudinal study presented at the ESMO Congress was based on the CANTO (CAncer TOxicities) cohort sponsored by Unicancer and directed by Professor Fabrice André, Director of Research at Gustave Roussy. This was used to examine the factors associated with amenorrhoea. The data base is composed of information from 26 French Cancer Centres from which 12,000 women with localised breast cancer have been followed over ten years to assess the impact of chronic toxicity on their quality of life.

Amenorrhoea is more common with advancing age and is associated with more side effects.

 “The strength of the CANTO Amenorrhoea study is to have been able to work on such a large cohort with longitudinal follow-up,” explained Dr Rayan Kabirian. This prospective analysis is based on 1,676 non-menopausal patients from the CANTO cohort aged between 18 and 50 years (median age 42 years), who had received either dual agent chemotherapy (91%) or  single-agent anthracycline-based or taxane-based chemotherapy. Within this cohort, 75% of women were on hormone therapy and 25% had received trastuzumab, a targeted therapy used in HER2+ breast cancer. Assessments were carried out at one year, two years and four years from diagnosis.

The findings presented at the ESMO Congress showed that, in addition to age and hormone therapy, two major factors that were already recognised as being associated with chemotherapy-induced amenorrhoea, two other factors were also relevant: a low body mass index and the use of a taxane contributed to the absence of periods in these patients. The study also showed that conversely, trastuzumab appeared to be associated with a lesser risk of absence of menstrual cycles.  

A second, more-limited, analysis on 745 women from the CANTO cohort revealed substantial differences according to age. Indeed, 45% of women between 18 and 34 had recovered their cycles at one year from diagnosis. Of this group, only 26% remained amenorrhoeic at 4 years from diagnosis. By contrast, only 7% of patients aged over 40 had re-established periods at the end of the first year and 78% of this age group remained amenorrheic at the 4-year annual assessment.   

Finally, the connection between chemotherapy-induced amenorrhoea and quality of life measures was explored. This showed that those women who had not re-established their cycles by 4 years were at greater risk of deleterious effects on their sexual health, were more likely to suffer side effects of chemotherapy (dry mouth, disturbed taste sensation, hair loss, etc.) and to have problems with attention and concentration.

“This study, well recognised in follow-up of cancer, opens a route to new ways of directing the clinical examination in order to improve the care pathway for patients and to offer them tailored support care,” concluded Dr Kabirian.

Abstract n°1551O
Factors associated with chemotherapy (CT)-related amenorrhea (CRA) and its relationship with quality of life (QOL) in premenopausal women with early breast cancer (BC): results from the prospective CANTO cohort study
Sunday 11th September | 8.30 – 8.40 am