Ovarian function after chemotherapy in young breast cancer survivors

Background As cure rates for breast cancer improve, there is increasing evidence that late effects of treatment—and impaired fertility in particular—are emerging as important concerns among young breast cancer survivors. Older reports have evaluated the occurrence of amenorrhea after treatment, but few data have been reported about the incidence of biochemical evidence for impaired ovarian function in patients who do not become overtly menopausal. Methods We conducted a cross-sectional study evaluating anti-Mullerian hormone (amh) in premenopausal chemotherapy-treated breast cancer survivors and control patients. Random serum levels of amh and other relevant clinical data were collected for 100 premenopausal chemotherapy-treated breast cancer survivors and 76 control subjects. Subgroup analyses were performed for women with regular menstrual cycles at the time of amh testing. Results After adjustment for age, amh was significantly lower in the overall group of patients receiving chemotherapy ( p = 0.002) and in the subgroup reporting normal cycles ( p = 0.03). Cyclophosphamide produced a significant dosedependent reduction in amh ( p < 0.001); trastuzumab was associated with increased amh in survivors with normal cycles. Overall, serum amh in survivors was roughly equivalent to that measured in control patients 12 years older. Conclusions Young breast cancer survivors often experience significant impairment of ovarian function despite having normal menstrual cycles after treatment. Those results have important implications for patient counselling and the timing of possible referral to a fertility specialist.