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Henze M, Stuckey BGA. Endocrine consequences of breast cancer therapy and survivorship. Climacteric 2024:1-7. [PMID: 38867405 DOI: 10.1080/13697137.2024.2354725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/28/2024] [Indexed: 06/14/2024]
Abstract
Breast cancer survivorship is increasing, due to earlier diagnosis of the disease and more effective therapies. Long-term endocrine sequelae, including early menopause, bone health, fertility implications and menopausal symptoms, are important survivorship issues. Ovarian failure is common with chemotherapy and options for preserving fertility in young women include ovarian suppression during chemotherapy and oocyte or embryo cryopreservation before chemotherapy. Tamoxifen as adjunct therapy in premenopausal women leads to ovarian stimulation, sometimes ovulation and occasionally pregnancy with important teratogenic implications. Aromatase inhibitor therapy with or without gonadotrophin releasing hormone (GnRH) agonist leads to profound bone loss and anti-resorptive therapy is advised to prevent fracture. Tamoxifen acts to preserve bone in postmenopausal women but not premenopausal women. Pregnancy is not discouraged in young women with early breast cancer, even to the point of pausing adjunct therapy in order to conceive. However, menopausal hormone therapy is discouraged even years later. Non-hormonal therapy for menopausal symptoms in breast cancer survivors is available but, in some cases, estrogen-containing therapy may be worthy of consideration for quality of life in the informed patient.
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Affiliation(s)
- Meg Henze
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Bronwyn G A Stuckey
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Keogh Institute for Medical Research, Nedlands, WA, Australia
- Medical School, University of Western Australia, Nedlands, WA, Australia
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2
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Bilc M, Pollmann N, Buchholz A, Lauche R, Cramer H. Yoga and meditation for menopausal symptoms in breast cancer survivors: a qualitative study exploring participants' experiences. Support Care Cancer 2024; 32:413. [PMID: 38842686 PMCID: PMC11156729 DOI: 10.1007/s00520-024-08603-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE Breast cancer survivors commonly experience menopausal symptoms, specifically when undergoing antihormonal therapy. Unfortunately, they often have a restricted range of treatment options available to alleviate menopausal symptoms. The objective of this qualitative study was to explore breast cancer survivors' experiences and effects of a yoga and meditation intervention supplementing previously reported RCT outcomes. METHODS The qualitative data included in this study were part of a larger randomized controlled trial which evaluated the efficacy and safety of a 12-week yoga and meditation intervention on menopausal symptoms in breast cancer survivors. All participants who underwent the yoga intervention (n = 19) were invited to take part in semi-structured interviews after all quantitative data collection had been completed. Interviews (n = 9) were recorded, transcribed, and then coded into superordinate themes using thematic analysis. RESULTS Nine female participants were interviewed, and the following themes emerged: (1) representations and expectations from the yoga intervention; (2) course structure and implementation; (3) perceptions and effects of the intervention (at emotional, physical, behavioral, and spiritual level); (4) differences between the study yoga intervention and other physical activities. CONCLUSIONS In accordance with the accounts of participants, yoga might offer a promising intervention for breast cancer survivors. All those interviewed either currently attended a yoga class or expressed a desire to continue practicing yoga. Additionally, our findings inform future studies regarding aspects such as the importance of extending outcome measures beyond specific cancer-related complains, the advantages of addressing homogenous groups (i.e., breast cancer specific), or considering that different intervention components might need different assistance to encourage long-term use.
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Affiliation(s)
- Mirela Bilc
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Nina Pollmann
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Analena Buchholz
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Romy Lauche
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
| | - Holger Cramer
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany.
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany.
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia.
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Cucciniello L, Miglietta F, Guarneri V, Puglisi F. Managing sexual health challenges in breast cancer survivors: A comprehensive review. Breast 2024; 76:103754. [PMID: 38820922 PMCID: PMC11170478 DOI: 10.1016/j.breast.2024.103754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/12/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024] Open
Abstract
The significant advancements in breast cancer management have led to an increase in the prevalence of breast cancer survivors. Despite their efficacy, these treatments can cause a variable range of side effects, significantly deteriorating the patients' quality of life. Sexual dysfunction, and in particular the genitourinary syndrome of menopause, represent one of the major causes of quality-of-life impairment among breast cancer patients, potentially affecting treatment adherence and compliance. If in the general population, hypoestrogenism-related symptoms are typically managed through systemic or topical estrogen administration, this approach is contraindicated in breast cancer patients for the potential increased risk of disease recurrence, urging the investigation of alternative measures. The aim of this review is to summarize the most up-to-date pharmacological and non-pharmacological interventions, as well as supportive measures, available for the management of sexual dysfunctions in breast cancer patients and survivors.
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Affiliation(s)
- Linda Cucciniello
- Department of Medicine, University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy.
| | - Federica Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Istituto Oncologico Veneto - IOV IRCCS, Padova, Italy.
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Istituto Oncologico Veneto - IOV IRCCS, Padova, Italy.
| | - Fabio Puglisi
- Department of Medicine, University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy.
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4
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Choi E, Lee JK, Baek JK, Chung Y, Kim H, Yun BH, Seo SK. Hormone replacement therapy and breast cancer incidence in Korean women. Maturitas 2024; 183:107946. [PMID: 38412593 DOI: 10.1016/j.maturitas.2024.107946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES After the 2002 Women's Health Initiative (WHI) study, the global use of menopausal hormone therapy (MHT) declined, and despite subsequent studies indicating a low risk of breast cancer, concerns about MHT usage persist. We examined the relationship between changes in MHT use and changes in the incidence of breast cancer from 2002 to 2020 in South Korea. STUDY DESIGN This study used tumor registry information from 2002 to 2020 from the Korean Statistical Information Service and analyzed the incidence rate of invasive breast cancer in women, who were divided into two age groups: <50 and >50 years. The numbers of MHT prescriptions in Korea between 2002 and 2020 was determined from pharmacy data. RESULTS The incidence of breast cancer per 100,000 women in South Korea increased from 34.3 in 2002 to 96.4 in 2020. Breast cancer incidence rates increased annually in both groups of women (those aged under and over 50 years), with no significant difference between the two (p = 0.614). Prescriptions for estrogen therapy (ET) in 2020 were 52.7 % lower than those in 2002. Prescriptions for estrogen-progesterone therapy (EPT) decreased by 27.9 % over the same period. Conversely, tibolone prescriptions, which had initially decreased by 25.4 % in 2004, subsequently showed a steady increase and were 93.6 % higher in 2020 than in 2002. CONCLUSION The incidence of breast cancer increased annually in Korean women of all ages; however, the use of ET and EPT for MHT has declined since 2002, particularly the use of EPT after 2010. MHT, especially EPT, did not significantly increase the incidence of breast cancer in Korean women.
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Affiliation(s)
- Euna Choi
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Kyung Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Kyung Baek
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yunsoo Chung
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Heeyon Kim
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bo Hyon Yun
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Dumas E, Grandal Rejo B, Gougis P, Houzard S, Abécassis J, Jochum F, Marande B, Ballesta A, Del Nery E, Dubois T, Alsafadi S, Asselain B, Latouche A, Espie M, Laas E, Coussy F, Bouchez C, Pierga JY, Le Bihan-Benjamin C, Bousquet PJ, Hotton J, Azencott CA, Reyal F, Hamy AS. Concomitant medication, comorbidity and survival in patients with breast cancer. Nat Commun 2024; 15:2966. [PMID: 38580683 PMCID: PMC10997660 DOI: 10.1038/s41467-024-47002-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/14/2024] [Indexed: 04/07/2024] Open
Abstract
Between 30% and 70% of patients with breast cancer have pre-existing chronic conditions, and more than half are on long-term non-cancer medication at the time of diagnosis. Preliminary epidemiological evidence suggests that some non-cancer medications may affect breast cancer risk, recurrence, and survival. In this nationwide cohort study, we assessed the association between medication use at breast cancer diagnosis and survival. We included 235,368 French women with newly diagnosed non-metastatic breast cancer. In analyzes of 288 medications, we identified eight medications positively associated with either overall survival or disease-free survival: rabeprazole, alverine, atenolol, simvastatin, rosuvastatin, estriol (vaginal or transmucosal), nomegestrol, and hypromellose; and eight medications negatively associated with overall survival or disease-free survival: ferrous fumarate, prednisolone, carbimazole, pristinamycin, oxazepam, alprazolam, hydroxyzine, and mianserin. Full results are available online from an interactive platform ( https://adrenaline.curie.fr ). This resource provides hypotheses for drugs that may naturally influence breast cancer evolution.
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Affiliation(s)
- Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
- INSERM, U900, 75005, Paris, France
- MINES ParisTech, PSL Research University, CBIO-Centre for Computational Biology, 75006, Paris, France
| | - Beatriz Grandal Rejo
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
| | - Paul Gougis
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
| | - Sophie Houzard
- Health Data and Assessment, Health Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 92100, Boulogne-Billancourt, France
| | - Judith Abécassis
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
- INRIA, Paris-Saclay University, CEA, Palaiseau, 91120, France
| | - Floriane Jochum
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Benjamin Marande
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
| | - Annabelle Ballesta
- INSERM UMR-S 900, Institut Curie, MINES ParisTech CBIO, PSL Research University, 92210, Saint-Cloud, France
| | - Elaine Del Nery
- Département de Recherche Translationnelle - Plateforme Biophenics, PICT-IBISA, PSL Research University, Paris, France
| | - Thierry Dubois
- Institut Curie - PSL Research University Translational Research Department Breast Cancer Biology Group 26 rue d'Ulm, 75005, Paris, France
| | - Samar Alsafadi
- Institut Curie, PSL Research University, Uveal Melanoma Group, Translational Research Department, Paris, France
| | | | - Aurélien Latouche
- INSERM, U900, 75005, Paris, France
- INSERM UMR-S 900, Institut Curie, MINES ParisTech CBIO, PSL Research University, 92210, Saint-Cloud, France
- Conservatoire National des Arts et Métiers, Paris, France
| | - Marc Espie
- Breast diseases Center Hôpital saint Louis APHP, Université Paris Cité, Paris, France
| | - Enora Laas
- Department of Surgical Oncology, Université Paris Cité, Institut Curie, 75005, Paris, France
| | - Florence Coussy
- Department of Medical Oncology, Université Paris Cité, Institut Curie, 75005, Paris, France
| | - Clémentine Bouchez
- Breast diseases Center Hôpital saint Louis APHP, Université Paris Cité, Paris, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Université Paris Cité, Institut Curie, 75005, Paris, France
| | - Christine Le Bihan-Benjamin
- Health Data and Assessment, Health Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 92100, Boulogne-Billancourt, France
| | - Philippe-Jean Bousquet
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Équipe Labellisée Ligue Contre le Cancer, 13005, Marseille, France
- Health Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 92100, Boulogne-Billancourt, France
| | | | - Chloé-Agathe Azencott
- INSERM, U900, 75005, Paris, France
- MINES ParisTech, PSL Research University, CBIO-Centre for Computational Biology, 75006, Paris, France
- Institut Curie, PSL Research University, Paris, France
| | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France.
- Department of Surgical Oncology, Université Paris Cité, Institut Curie, 75005, Paris, France.
- Department of Surgery, Institut Jean Godinot, Reims, France.
| | - Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
- Department of Medical Oncology, Université Paris Cité, Institut Curie, 75005, Paris, France
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Hickey M, Basu P, Sassarini J, Stegmann ME, Weiderpass E, Nakawala Chilowa K, Yip CH, Partridge AH, Brennan DJ. Managing menopause after cancer. Lancet 2024; 403:984-996. [PMID: 38458217 DOI: 10.1016/s0140-6736(23)02802-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/18/2023] [Accepted: 12/11/2023] [Indexed: 03/10/2024]
Abstract
Globally, 9 million women are diagnosed with cancer each year. Breast cancer is the most commonly diagnosed cancer worldwide, followed by colorectal cancer in high-income countries and cervical cancer in low-income countries. Survival from cancer is improving and more women are experiencing long-term effects of cancer treatment, such as premature ovarian insufficiency or early menopause. Managing menopausal symptoms after cancer can be challenging, and more severe than at natural menopause. Menopausal symptoms can extend beyond hot flushes and night sweats (vasomotor symptoms). Treatment-induced symptoms might include sexual dysfunction and impairment of sleep, mood, and quality of life. In the long term, premature ovarian insufficiency might increase the risk of chronic conditions such as osteoporosis and cardiovascular disease. Diagnosing menopause after cancer can be challenging as menopausal symptoms can overlap with other common symptoms in patients with cancer, such as fatigue and sexual dysfunction. Menopausal hormone therapy is an effective treatment for vasomotor symptoms and seems to be safe for many patients with cancer. When hormone therapy is contraindicated or avoided, emerging evidence supports the efficacy of non-pharmacological and non-hormonal treatments, although most evidence is based on women older than 50 years with breast cancer. Vaginal oestrogen seems safe for most patients with genitourinary symptoms, but there are few non-hormonal options. Many patients have inadequate centralised care for managing menopausal symptoms after cancer treatment, and more information is needed about cost-effective and patient-focused models of care for this growing population.
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Affiliation(s)
- Martha Hickey
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and the Royal Women's Hospital, Melbourne, VIC, Australia.
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Jenifer Sassarini
- Department of Obstetrics and Gynaecology, School of Gynaecology, University of Glasgow, Glasgow, UK
| | - Mariken E Stegmann
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | | | - Cheng-Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Donal J Brennan
- Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland; Systems Biology Ireland, UCD School of Medicine, Dublin, Ireland
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Coronado PJ, Gómez A, Iglesias E, Fasero M, Baquedano L, Sánchez S, Ramírez-Polo I, de la Viuda E, Otero B, Llaneza P, Mendoza N, Lubián DM. Eligibility criteria for using menopausal hormone therapy in breast cancer survivors: a safety report based on a systematic review and meta-analysis. Menopause 2024; 31:234-242. [PMID: 38385734 DOI: 10.1097/gme.0000000000002317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
IMPORTANCE Menopause hormone therapy (MHT) effectively alleviates menopausal symptoms. However, it is generally not recommended for breast cancer survivors, although the scientific evidence is scarce. OBJECTIVE This study aimed to establish eligibility criteria for use of the MHT in breast cancer survivors based on a systematic review and meta-analysis of the literature. EVIDENCE REVIEW We conducted exhaustive literature searches until June 2022 in MEDLINE, The Cochrane Library, and EMBASE, using a tailored strategy with a combination of controlled vocabulary and search terms related to breast cancer survivors and MHT. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and assessed the risk of bias using the Cochrane and Risk of Bias in Non-randomized Studies - of Interventions tools. The quality of the evidence was graded according to grading quality of evidence and strength of recommendations criteria (A, high; B, moderate; C, low; and D, very low). We categorized MHT use into four levels: category 1 (no restrictions on use), category 2 (the benefits outweigh the risks), category 3 (the risks generally outweigh the benefits), and category 4 (MHT should not be used). FINDINGS A total of 12 studies met the eligibility criteria. Analysis of the three randomized clinical trials using combined MHT or tibolone revealed no significant differences concerning tumor recurrence (relative risk [RR], 1.46; 95% CI, 0.99-2.24). A combined analysis of randomized clinical trials, prospective, and retrospective trials found no elevated risk of recurrence (RR, 0.85; 95% CI, 0.54-1.33) or death (RR, 0.91; 95% CI, 0.38-2.19). The eligibility criteria for patients with hormone receptor (HR)-positive tumors fell into categories 3B and 3C for combined MHT or estrogen alone and 4A for tibolone. For HR-negative tumors, the category was 2B and 2C. CONCLUSIONS AND RELEVANCE Our findings suggest that MHT could be a viable treatment alternative for breast cancer survivors experiencing menopausal symptoms, especially those with HR-negative tumors. Personalized management is recommended for each peri/postmenopausal woman facing a diminished quality of life because of menopause symptoms. Further randomized trials are needed before considering changes to current standards of care.
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Affiliation(s)
- Pluvio J Coronado
- From the Women's Health Institute, Hospital Clinico San Carlos, IdISSC, School of Medicine, Complutense University, Madrid, Spain
| | - Ana Gómez
- Service of Gynecology and Obstetrics, Hospital General of Segovia, Spain
| | - Eva Iglesias
- Service of Gynecology and Obstetrics, Hospital de Valme, Sevilla, Spain
| | - María Fasero
- Corofas Menopause Clinic, Universidad Francisco de Victoria, Madrid, Spain
| | - Laura Baquedano
- Service of Obstetrics and Gynecology, Hospital Miguel Servet, Zaragoza University, Spain
| | - Sonia Sánchez
- Department of Obstetrics and Gynecology, Quiron Salud Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Isabel Ramírez-Polo
- Salud Sexual y Reproductiva, Unidad de Gestión Clínica Cayetano Roldan, San Fernando, Cádiz, Spain
| | - Esther de la Viuda
- Department of Obstetrics and Gynecology, Hospital Universitario de Guadalajara, Universidad de Alcalá de Henares, Spain
| | - Borja Otero
- Department of Obstetrics and Gynecology, Hospital de Cruces, University of the Basque Country, Bilbao, Spain
| | - Plácido Llaneza
- Department of Obstetrics and Gynecology, Hospital Central de Asturias, Faculty of Medicine, Oviedo University, Spain
| | - Nicolás Mendoza
- Department of Obstetrics and Gynecology, Faculty of Medicine, Granada University, Spain
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Lee JK, Yun H, Kim H, Yun BH, Seo SK. Tibolone and Breast Cancer. J Menopausal Med 2023; 29:92-96. [PMID: 38230592 PMCID: PMC10796206 DOI: 10.6118/jmm.23032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/25/2023] [Accepted: 12/27/2023] [Indexed: 01/18/2024] Open
Abstract
Tibolone, a selective tissue estrogenic activity regulator, is a synthetic steroid with distinct pharmacological and clinical characteristics in contrast to conventional menopausal hormone therapy. Tibolone induces estrogenic activity in the brain, vagina, and bone but remains inactive in the endometrium and breast. In particular, several studies have investigated whether tibolone usage increases the risk of breast cancer. This study aims to determine the effects of tibolone on the breast by focusing on the relation between tibolone use and breast cancer. Our investigation emphasizes recent studies, particularly those based on Asian populations.
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Affiliation(s)
- Jae Kyung Lee
- Departments of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hyewon Yun
- Departments of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Heeyon Kim
- Departments of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Bo Hyon Yun
- Departments of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Kyo Seo
- Departments of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
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Servayge J, Verduyn AC, Page A, Lagaert L, Tjalma WAA. Clinical guidelines for managing menopausal symptoms in women with (a history of) breast cancer. Facts Views Vis Obgyn 2023; 15:297-308. [PMID: 37963326 PMCID: PMC10832648 DOI: 10.52054/fvvo.15.4.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Background One in eight women will be diagnosed with breast cancer. At the time of diagnosis, 75% of patients are postmenopausal. Many will receive anti-hormone therapy, which often induces menopausal symptoms. Premenopausal breast cancer patients frequently become postmenopausal as a result of the treatment and often experience menopausal symptoms. The increased incidence of breast cancer, combined with longer survival, has led to an increase in the number of women experiencing menopausal symptoms. Therefore, the management of menopausal symptoms in women with a history or current breast cancer is a relevant and common clinical problem. Objectives To provide a clinically useful overview of the steps in the management of menopausal symptoms in women with (a history of) breast cancer. Materials and Methods A comprehensive literature review was conducted by authors JS and WT using the PubMed and Medline databases. Abstracts were critically appraised and, where appropriate, the full text was analysed. Main Outcome Measures Not applicable. Results Depending on the condition, either meta-analyses, randomised controlled trials or retrospective cohorts were identified. No evidence was found for some proposed treatments. Conclusions Menopausal symptoms in women with (a history of) breast cancer require a patient-tailored approach. Shared decision making is paramount and adequate up-to-date knowledge can help the breast cancer specialist to advise and guide patients accordingly. What is new? A comprehensive, clinically-based overview of evidence-based treatment options for menopausal symptoms in women with (a history of) breast cancer.
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Rentzeperi E, Pegiou S, Tsakiridis I, Kalogiannidis I, Kourtis A, Mamopoulos A, Athanasiadis A, Dagklis T. Diagnosis and Management of Osteoporosis: A Comprehensive Review of Guidelines. Obstet Gynecol Surv 2023; 78:657-681. [PMID: 38134337 DOI: 10.1097/ogx.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Importance Osteoporosis causes increased morbidity and mortality, and thus poses a significant economic burden to the health systems worldwide. Objective The aim of this study was to review and compare the most recently published major guidelines on diagnosis and management of this common medical entity. Evidence Acquisition A thorough comparative review of the most influential guidelines from the RACGP (Royal Australian College of General Practitioners), the ESCEO-IOF (European Society for Clinical and Economic Aspects of Osteoporosis-International Osteoporosis Foundation), the NOGG (National Osteoporosis Guideline Group), the NAMS (North American Menopause Society), the ES (Endocrine Society), and the ACOG (American College of Obstetricians and Gynecologists) was conducted. Results The reviewed guidelines generally agree on the definition, the criteria, and investigations used to diagnose osteoporosis. They also concur regarding the risk factors for osteoporosis and the suggested lifestyle modifications (calcium and vitamin D intake, normal body weight, reduction of alcohol consumption, and smoking cessation). However, there is lack of consensus on indications for fracture risk assessment in the general population and the exact indications for bone mineral density assessment. Referral to a bone specialist is reserved for complex cases of osteoporosis (NOGG, NAMS, and ACOG) or in case of inadequate access to care (RACGP). The use of hip protectors to reduce the risk of fractures is supported by RACGP, NOGG, and NAMS, solely for high-risk elderly patients in residential care settings. All guidelines reviewed recognize the efficacy of the pharmacologic agents (ie, bisphosphonates, denosumab, hormone therapy, and parathyroid hormone analogs). Nonetheless, recommendations regarding monitoring of pharmacotherapy differ, primarily in the case of bisphosphonates. The proposed intervals of repeat bone mineral density testing after initiation of drug therapy are set at 2 years (RACGP), 1-3 years (NAMS, ES, and ACOG), or 3-5 years (ESCEO-IOF and NOGG). All guidelines agree upon the restricted use of bone turnover markers only in bone specialist centers for treatment monitoring purposes. Finally, the definition of treatment failure varies among the reviewed guidelines. Conclusions Osteoporosis is a distressing condition for women, mainly those of postmenopausal age. Thus, it seems of paramount importance to develop consistent international practice protocols for more cost-effective diagnostic and management techniques, in order to improve women's quality of life.
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Affiliation(s)
| | | | | | | | | | | | | | - Themistoklis Dagklis
- Assistant Professor, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Casiano Evans EA, Hobson DTG, Aschkenazi SO, Alas AN, Balgobin S, Balk EM, Dieter AA, Kanter G, Orejuela FJ, Sanses TVD, Rahn DD. Nonestrogen Therapies for Treatment of Genitourinary Syndrome of Menopause: A Systematic Review. Obstet Gynecol 2023; 142:555-570. [PMID: 37543737 DOI: 10.1097/aog.0000000000005288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/25/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE To systematically review the literature and provide clinical practice guidelines regarding various nonestrogen therapies for treatment of genitourinary syndrome of menopause (GSM). DATA SOURCES MEDLINE, EMBASE, ClinicalTrials.gov , and Cochrane databases were searched from inception to July 2021. We included comparative and noncomparative studies. Interventions and comparators were limited to seven products that are commercially available and currently in use (vaginal dehydroepiandrosterone [DHEA], ospemifene, laser or energy-based therapies, polycarbophil-based vaginal moisturizer, Tibolone, vaginal hyaluronic acid, testosterone). Topical estrogen, placebo, other nonestrogen products, as well as no treatment were considered as comparators. METHODS OF STUDY SELECTION We double-screened 9,131 abstracts and identified 136 studies that met our criteria. Studies were assessed for quality and strength of evidence by the systematic review group. TABULATION, INTEGRATION, AND RESULTS Information regarding the participants, details on the intervention and comparator and outcomes were extracted from the eligible studies. Alternative therapies were similar or superior to estrogen or placebo with minimal increase in adverse events. Dose response was noted with vaginal DHEA and testosterone. Vaginal DHEA, ospemifene, erbium and fractional carbon dioxide (CO 2 ) laser, polycarbophil-based vaginal moisturizer, tibolone, hyaluronic acid, and testosterone all improved subjective and objective signs of atrophy. Vaginal DHEA, ospemifene, tibolone, fractional CO 2 laser, polycarbophil-based vaginal moisturizer, and testosterone improved sexual function. CONCLUSION Most nonestrogen therapies are effective treatments for the various symptoms of GSM. There are insufficient data to compare nonestrogen options to each other.
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Affiliation(s)
- Elizabeth A Casiano Evans
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Texas at San Antonio, San Antonio, the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center, Dallas, and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, Michigan; the Division of Urogynecology, ProHealth Women's Services, Waukesha Memorial Hospital, Waukesha, Wisconsin; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; the Departments of Obstetrics and Gynecology and Urology, MedStar Washington Hospital Center, Georgetown University School of Medicine, and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Howard University College of Medicine, Washington, DC; and the Salinas Valley Memorial Healthcare System, Salinas, California
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12
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Lara LA, Cartagena-Ramos D, Figueiredo JB, Rosa-E-Silva ACJ, Ferriani RA, Martins WP, Fuentealba-Torres M. Hormone therapy for sexual function in perimenopausal and postmenopausal women. Cochrane Database Syst Rev 2023; 8:CD009672. [PMID: 37619252 PMCID: PMC10449239 DOI: 10.1002/14651858.cd009672.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND The perimenopausal and postmenopausal periods are associated with many symptoms, including sexual complaints. This review is an update of a review first published in 2013. OBJECTIVES We aimed to assess the effect of hormone therapy on sexual function in perimenopausal and postmenopausal women. SEARCH METHODS On 19 December 2022 we searched the Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS, ISI Web of Science, two trials registries, and OpenGrey, together with reference checking and contact with experts in the field for any additional studies. SELECTION CRITERIA We included randomized controlled trials that compared hormone therapy to either placebo or no intervention (control) using any validated assessment tool to evaluate sexual function. We considered hormone therapy: estrogen alone; estrogen in combination with progestogens; synthetic steroids, for example, tibolone; selective estrogen receptor modulators (SERMs), for example, raloxifene, bazedoxifene; and SERMs in combination with estrogen. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. We analyzed data using mean differences (MDs) and standardized mean differences (SMDs). The primary outcome was the sexual function score. Secondary outcomes were the domains of sexual response: desire; arousal; lubrication; orgasm; satisfaction; and pain. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 36 studies (23,299 women; 12,225 intervention group; 11,074 control group), of which 35 evaluated postmenopausal women; only one study evaluated perimenopausal women. The 'symptomatic or early postmenopausal women' subgroup included 10 studies, which included women experiencing menopausal symptoms (symptoms such as hot flushes, night sweats, sleep disturbance, vaginal atrophy, and dyspareunia) or early postmenopausal women (within five years after menopause). The 'unselected postmenopausal women' subgroup included 26 studies, which included women regardless of menopausal symptoms and women whose last menstrual period was more than five years earlier. No study included only women with sexual dysfunction and only seven studies evaluated sexual function as a primary outcome. We deemed 20 studies at high risk of bias, two studies at low risk, and the other 14 studies at unclear risk of bias. Nineteen studies received commercial funding. Estrogen alone versus control probably slightly improves the sexual function composite score in symptomatic or early postmenopausal women (SMD 0.50, 95% confidence interval (CI) (0.04 to 0.96; I² = 88%; 3 studies, 699 women; moderate-quality evidence), and probably makes little or no difference to the sexual function composite score in unselected postmenopausal women (SMD 0.64, 95% CI -0.12 to 1.41; I² = 94%; 6 studies, 608 women; moderate-quality evidence). The pooled result suggests that estrogen alone versus placebo or no intervention probably slightly improves sexual function composite score (SMD 0.60, 95% CI 0.16 to 1.04; I² = 92%; 9 studies, 1307 women, moderate-quality evidence). We are uncertain of the effect of estrogen combined with progestogens versus placebo or no intervention on the sexual function composite score in unselected postmenopausal women (MD 0.08 95% CI -1.52 to 1.68; 1 study, 104 women; very low-quality evidence). We are uncertain of the effect of synthetic steroids versus control on the sexual function composite score in symptomatic or early postmenopausal women (SMD 1.32, 95% CI 1.18 to 1.47; 1 study, 883 women; very low-quality evidence) and of their effect in unselected postmenopausal women (SMD 0.46, 95% CI 0.07 to 0.85; 1 study, 105 women; very low-quality evidence). We are uncertain of the effect of SERMs versus control on the sexual function composite score in symptomatic or early postmenopausal women (MD -1.00, 95% CI -2.00 to -0.00; 1 study, 215 women; very low-quality evidence) and of their effect in unselected postmenopausal women (MD 2.24, 95% 1.37 to 3.11 2 studies, 1525 women, I² = 1%, low-quality evidence). We are uncertain of the effect of SERMs combined with estrogen versus control on the sexual function composite score in symptomatic or early postmenopausal women (SMD 0.22, 95% CI 0.00 to 0.43; 1 study, 542 women; very low-quality evidence) and of their effect in unselected postmenopausal women (SMD 2.79, 95% CI 2.41 to 3.18; 1 study, 272 women; very low-quality evidence). The observed heterogeneity in many analyses may be caused by variations in the interventions and doses used, and by different tools used for assessment. AUTHORS' CONCLUSIONS Hormone therapy treatment with estrogen alone probably slightly improves the sexual function composite score in women with menopausal symptoms or in early postmenopause (within five years of amenorrhoea), and in unselected postmenopausal women, especially in the lubrication, pain, and satisfaction domains. We are uncertain whether estrogen combined with progestogens improves the sexual function composite score in unselected postmenopausal women. Evidence regarding other hormone therapies (synthetic steroids and SERMs) is of very low quality and we are uncertain of their effect on sexual function. The current evidence does not suggest the beneficial effects of synthetic steroids (for example tibolone) or SERMs alone or combined with estrogen on sexual function. More studies that evaluate the effect of estrogen combined with progestogens, synthetic steroids, SERMs, and SERMs combined with estrogen would improve the quality of the evidence for the effect of these treatments on sexual function in perimenopausal and postmenopausal women.
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Affiliation(s)
- Lucia A Lara
- Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | | | - Jaqueline Bp Figueiredo
- Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
- Ultrasonography and Retraining Medical School of Ribeirao Preto (EURP), Ribeirao Preto, Brazil
| | - Ana Carolina Js Rosa-E-Silva
- Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Rui A Ferriani
- Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
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Fasero M, Quereda F, Andraca L, Coronado PJ. Pharmacological interactions and menopausal hormone therapy: a review. Menopause 2023:00042192-990000000-00211. [PMID: 37449718 DOI: 10.1097/gme.0000000000002219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
IMPORTANCE AND OBJECTIVE Menopausal hormone therapy (HT) is widely used, and there are several statements of international scientific societies to guide prescribers; however, a summary of existing literature about possible drug interactions with HT does not exist, although many midlife women take medications for other conditions. Therefore, our objective was to create a document that presents and synthesizes the most relevant interactions. The impact of the interaction itself and the number of candidates for HT who are likely to use other treatments are considered based on the best available evidence. METHODS A systematic review was performed to determine the best evidence of interaction effects on relevant outcomes of interest for decision making. A working framework was developed to formulate explicit and reasoned recommendations according to four predefined categories for coadministration: (1) can be used without expected risks, (2) acceptable use (no evidence of negative interaction), (3) alternative treatment should be considered, and (4) nonuse without express justification. The project protocol was registered in the Open Science Framework platform (doi: 10.17605/OSF.IO/J6WBC) and in PROSPERO (registration number CRD42020166658). RESULTS Studies targeting our objective are scarce, but 23 pharmacological groups were assigned to one of the predefined categories of recommendation for concomitant use of HT. Vaginal HT was assigned to category 1 for 21 of the analyzed pharmacological groups. For oral and transdermal HT (estrogen-only or combined) and tibolone, there were 12 pharmacological groups assigned to category 1, 12 to category 2, 5 to category 3, and 4 to category 4. Results are shown in crossed-tables that are useful for counseling and prescription. DISCUSSION AND CONCLUSIONS Available evidence of HT interactions with other drugs is scarce and mainly indirect. It comes from biological plausibility, knowledge of extensive concomitant use without reported incidents, and/or extrapolation from hormonal contraception, but there are pharmacological groups in all categories showing that information is useful. These eligibility criteria summarize it and can help in the decision process of HT coadministration with other drugs. Decisions should be taken based on these recommendations but also individualized risk/benefit evaluation, according to underlying pathology, patient's clinical requirements, and the existence or nonexistence of alternatives.
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Affiliation(s)
- Maria Fasero
- From the Menopause Unit, Clínica Corofas, Universidad Francisco de Vitoria, Madrid, Spain
| | - Francisco Quereda
- Hospital Universitario de San Juan de Alicante, Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Leire Andraca
- Sociedad Española de Farmacia Comunitaria (SEFAC), Madrid, Spain
| | - Pluvio J Coronado
- Departamento de Obstetricia y Ginecología, Hospital clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
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Sourouni M, Kiesel L. Menopausal Hormone Therapy and the Breast: A Review of Clinical Studies. Breast Care (Basel) 2023; 18:164-171. [PMID: 37928811 PMCID: PMC10624058 DOI: 10.1159/000530205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/16/2023] [Indexed: 11/07/2023] Open
Abstract
Background Women in the peri- or postmenopause can experience symptoms related to the gradual degradation of ovarian function. Hormone replacement therapy (HRT) is the most effective therapy to treat common menopausal symptoms such as hot flashes and vaginal discomfort. However, safety concerns have been raised revolving, among others also, around the risk of breast cancer. Methods This article is based on a selective literature search for relevant studies regarding HRT use and the risk of breast cancer in the general population or BRCA carriers, the risk of breast cancer recurrence, or the risk of breast cancer in situ. Summary HRT can lead to little or no increase in breast cancer risk. The risk depends on the duration and composition of the HRT and decreases after stopping the treatment. Data assessing the oncological safety of HRT after breast cancer are inconsistent. According to current knowledge, HRT is fundamentally contraindicated after breast cancer but can be individually considered after a risk-benefit assessment and when nonhormonal therapies have failed. The same applies to HRT after DCIS, which should not be routinely offered but nonetheless can be considered in individual cases. HRT can be offered up to the age of natural menopause for BRCA mutation carriers who are undergoing risk-reducing bilateral salpingo-oophorectomy and do not have a personal history of breast cancer, but is contraindicated in BRCA mutation carriers who have already had breast cancer.
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Affiliation(s)
- Marina Sourouni
- Department of Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Ludwig Kiesel
- Department of Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
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Merlino L, D’Ovidio G, Matys V, Piccioni MG, Porpora MG, Senatori R, Viscardi MF, Vitale A, Della Rocca C. Therapeutic Choices for Genitourinary Syndrome of Menopause (GSM) in Breast Cancer Survivors: A Systematic Review and Update. Pharmaceuticals (Basel) 2023; 16:ph16040550. [PMID: 37111307 PMCID: PMC10142093 DOI: 10.3390/ph16040550] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023] Open
Abstract
(1) Background: Genitourinary syndrome of menopause (GSM) is a medical condition that can affect breast cancer survivors (BCS). This is a complication that often can occur as a result of breast cancer treatment, causing symptoms such as vaginal dryness, itching, burning, dyspareunia, dysuria, pain, discomfort, and impairment of sexual function. BCS who experience these symptoms negatively impact multiple aspects of their quality of life to the point that some of them fail to complete adjuvant hormonal treatment; (2) Methods: In this systematic review of the literature, we have analyzed possible pharmacological and non-pharmacological treatments for GSM in BCS. We reviewed systemic hormone therapy, local hormone treatment with estrogens and androgens, the use of vaginal moisturizers and lubricants, ospemifene, and physical therapies such as radiofrequency, electroporation, and vaginal laser; (3) Results: The data available to date demonstrate that the aforementioned treatments are effective for the therapy of GSM and, in particular, vulvovaginal atrophy in BCS. Where possible, combination therapy often appears more useful than using a single line of treatment; (4) Conclusions: We analyzed the efficacy and safety data of each of these options for the treatment of GSM in BCS, emphasizing how often larger clinical trials with longer follow-ups are needed.
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Affiliation(s)
- Lucia Merlino
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Giulia D’Ovidio
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Viviana Matys
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Maria Grazia Piccioni
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Maria Grazia Porpora
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Roberto Senatori
- Italian Society of Colposcopy and Cervicovaginal Pathology (SICPCV), 00186 Rome, Italy
| | - Maria Federica Viscardi
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Antonio Vitale
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Cattolica del Sacro Cuore University, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Carlo Della Rocca
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, 04100 Latina, Italy
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Gompel A. Menopause hormone treatment after cancer. Climacteric 2023; 26:240-247. [PMID: 37011657 DOI: 10.1080/13697137.2023.2176216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Regular improvement in survival of women after treatment for cancer has been reached in these last years. Menopause hormone therapy (MHT) remains the most efficient treatment to alleviate climacteric symptoms and improve quality of life in symptomatic women. The long-term effects of estrogen deficiency can be, at least partially, prevented by MHT. However, using MHT in an oncologic context can be associated with contraindications. Patients who have experienced breast cancer frequently face severe climacteric symptoms, but results from randomized trials are not in favor of using MHT in these women. Three randomized trials are available in women treated by MHT after ovarian cancer, and report better survival rates in the active group of treatment, suggesting that, at least in serous high-grade ovarian carcinoma, MHT could be allowed. No robust data are available for MHT after endometrial carcinoma. According to various guidelines, MHT could be possible in low grades with good prognosis. Progestogen, however, is not contraindicated and can help to alleviate climacteric symptoms. Squamous cell cervical carcinoma is not hormone-dependent and therefore patients can be treated with MHT without restrictions, whereas cervical adenocarcinoma is likely to be estrogen-dependent, despite lack of robust data, and thus only progesterone or progestin might be potentially used. It is possible that, in future, better molecular characterization of genomic profiles of various cancers may allow MHT to be used with some patients.
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Affiliation(s)
- A Gompel
- Université Paris Cité, Paris, France
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17
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Sund M, Garmo H, Andersson A, Margolin S, Ahlgren J, Valachis A. Estrogen therapy after breast cancer diagnosis and breast cancer mortality risk. Breast Cancer Res Treat 2023; 198:361-368. [PMID: 36773184 PMCID: PMC10020306 DOI: 10.1007/s10549-023-06871-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE The safety of local estrogen therapy in patients on adjuvant endocrine treatment is questioned, but evidence on the issue is scarce. This nested case-control registry-based study aimed to investigate whether estrogen therapy affects breast cancer mortality risk in women on adjuvant endocrine treatment. METHODS In a cohort of 15,198 women diagnosed with early hormone receptor (HR)-positive breast cancer and adjuvant endocrine treatment, 1262 women died due to breast cancer and were identified as cases. Each case was matched with 10 controls. Exposure to estrogen therapy with concurrent use of aromatase inhibitors (AIs), tamoxifen, or both sequentially, was compared between cases and controls. RESULTS No statistically significant difference in breast cancer mortality risk was seen in patients with exposure to estrogen therapy concurrent to endocrine treatment, neither in short-term or in long-term estrogen therapy use. CONCLUSIONS The study strengthens current evidence on local estrogen therapy use in breast cancer survivors, showing no increased risk for breast cancer mortality in patients on adjuvant AIs or tamoxifen.
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Affiliation(s)
- Maria Sund
- Department of Oncology, Faculty of Medicine and Health, Örebro University Hospital, Örebro University, 70182, Örebro, Sweden
| | - Hans Garmo
- Sweden Regional Cancer Center, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Anne Andersson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Sara Margolin
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ahlgren
- Sweden Regional Cancer Center, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Antonis Valachis
- Department of Oncology, Faculty of Medicine and Health, Örebro University Hospital, Örebro University, 70182, Örebro, Sweden.
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18
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Yuk JS. Endometrial cancer risk with menopausal hormone therapy: Health Insurance Database in South Korea-based cohort study. Int J Gynaecol Obstet 2023. [PMID: 36964935 DOI: 10.1002/ijgo.14753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To determine the risk of endometrial cancer according to the types of menopausal hormones used. METHODS This retrospective cohort study recruited postmenopausal women older than 40 years from 2003 to 2011, utilizing data from the Korean national health insurance system from 2002 to 2019. The menopausal hormone therapy (MHT) group consisted of women who had been prescribed MHT for greater than 6 months between 2003 and 2011. The non-MHT group consisted of women who had never used menopausal hormones between 2003 and 2011. RESULTS A non-MHT group of 1 000 550 women and a MHT group of 353 025 women were chosen. In comparison to never-users, the risk of endometrial cancer was not higher in women who reported last using tibolone (adjusted hazard ratio [aHR] 1.08, 95% confidence interval [CI] 0.96-1.2), combined estrogen plus progestin by the manufacturer (aHR 0.83, 0.72-0.96), combined estrogen plus progestin by the physician (aHR 0.88, 0.7-1.12), and transdermal estrogen (aHR 1.13, 0.36-3.52). CONCLUSIONS Tibolone, combined estrogen plus progestin by the physician, and transdermal estrogen do not affect the risk of endometrial cancer. The combination of estrogen plus progestin by the manufacturer decreases the risk of endometrial cancer.
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Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
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Donohoe F, O’Meara Y, Roberts A, Comerford L, Kelly CM, Walshe JM, Lundy D, Hickey M, Brennan DJ. Using menopausal hormone therapy after a cancer diagnosis in Ireland. Ir J Med Sci 2023; 192:45-55. [PMID: 35141870 PMCID: PMC9892117 DOI: 10.1007/s11845-022-02947-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/01/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Menopause may cause a constellation of symptoms that affect quality of life. Many women will have menopause induced or exacerbated by treatment for cancer whether that be through surgery, chemotherapy, radiotherapy, or anti-endocrine therapy. As treatments advance, the number of people living with and beyond a cancer diagnosis is set to increase over the coming years meaning more people will be dealing with the after effects of cancer and its treatment. AIMS This review aims to summarise available data to guide clinicians treating women with menopausal symptoms after the common cancer diagnoses encountered in Ireland. The use of menopausal hormone therapy is discussed as well as non-hormonal and non-pharmacological options. CONCLUSIONS Managing menopausal symptoms is an important consideration for all physicians involved in the care of people living with and beyond a cancer diagnosis. High-quality data may not be available to guide treatment decisions, and, thus, it is essential to take into account the impact of the symptoms on quality of life as well as the likelihood of recurrence in each individual case.
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Affiliation(s)
- Fionán Donohoe
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Yvonne O’Meara
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Aidin Roberts
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Louise Comerford
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Catherine M. Kelly
- Dept. of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Janice M. Walshe
- Dept. of Medical Oncology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
| | - Deirdre Lundy
- Reproductive and Sexual Health Co-Ordinator, Irish College of General Practitioners, Lincoln Place, Dublin 2, Ireland
| | - Martha Hickey
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women’s Hospital, Melbourne, VIC Australia
| | - Donal J. Brennan
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland ,UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Belfield, Dublin 4, Ireland
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Hamoda H, Mukherjee A, Morris E, Baldeweg SE, Jayasena CN, Briggs P, Moger S. Authors reply: 'Response to the British Menopause society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology position statement - Best practice recommendations for the care of women experiencing the menopause'. Post Reprod Health 2022; 28:254-258. [PMID: 36374484 DOI: 10.1177/20533691221141132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
| | | | - Edward Morris
- Norfolk and Norwich University Hospitals, Norwic, UK
| | | | | | | | - Sara Moger
- 83690British Menopause Society, Marlow, UK
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21
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Ye L, Knox B, Hickey M. Management of Menopause Symptoms and Quality of Life during the Menopause Transition. Endocrinol Metab Clin North Am 2022; 51:817-836. [PMID: 36244695 DOI: 10.1016/j.ecl.2022.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Some women experience bothersome symptoms around the time of menopause that may have a negative impact on their quality of life and prompt them to seek treatments. Menopausal hormone therapy was historically the treatment of choice. However, medical contraindications and personal preference for nonhormonal therapy have prompted the evaluation of a range of nonhormonal pharmacologic and non-pharmacologic therapies. This review provides an update focusing on the latest evidence-based approach for the management of bothersome symptoms of menopause.
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Affiliation(s)
- Louie Ye
- The Royal Women's Hospital, 20 Flemington Road, Melbourne, Victoria 3052, Australia; The Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Lv 7 20 Flemington Road, Melbourne, Victoria 3052, Australia
| | - Benita Knox
- The Royal Women's Hospital, 20 Flemington Road, Melbourne, Victoria 3052, Australia
| | - Martha Hickey
- The Royal Women's Hospital, 20 Flemington Road, Melbourne, Victoria 3052, Australia; The Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Lv 7 20 Flemington Road, Melbourne, Victoria 3052, Australia.
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22
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Mendoza N, Ramírez I, de la Viuda E, Coronado P, Baquedano L, Llaneza P, Nieto V, Otero B, Sánchez-Méndez S, de Frutos VÁ, Andraca L, Barriga P, Benítez Z, Bombas T, Cancelo MJ, Cano A, Branco CC, Correa M, Doval JL, Fasero M, Fiol G, Garello NC, Genazzani AR, Gómez AI, Gómez MÁ, González S, Goulis DG, Guinot M, Hernández LR, Herrero S, Iglesias E, Jurado AR, Lete I, Lubián D, Martínez M, Nieto A, Nieto L, Palacios S, Pedreira M, Pérez-Campos E, Plá MJ, Presa J, Quereda F, Ribes M, Romero P, Roca B, Sánchez-Capilla A, Sánchez-Borrego R, Santaballa A, Santamaría A, Simoncini T, Tinahones F, Calaf J. Eligibility criteria for Menopausal Hormone Therapy (MHT): a position statement from a consortium of scientific societies for the use of MHT in women with medical conditions. MHT Eligibility Criteria Group. Maturitas 2022; 166:65-85. [PMID: 36081216 DOI: 10.1016/j.maturitas.2022.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/21/2022] [Accepted: 08/17/2022] [Indexed: 11/26/2022]
Abstract
This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.
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Affiliation(s)
- Nicolás Mendoza
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain.
| | - Isabel Ramírez
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | - Pluvio Coronado
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Laura Baquedano
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Plácido Llaneza
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Verónica Nieto
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Borja Otero
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | | | - Leire Andraca
- Sociedad Española de Farmacia Comunitaria (SEFAC), Spain
| | | | - Zully Benítez
- Federación Latino Americana de Sociedades de Climaterio y Menopausia (FLASCYM)
| | - Teresa Bombas
- Red Iberoamericana de Salud Sexual y Reproductiva (REDISSER)
| | | | - Antonio Cano
- European Menopause and Andropause Society (EMAS)
| | | | | | - José Luis Doval
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - María Fasero
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Gabriel Fiol
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Nestor C Garello
- Federación Latino-Americana de Sociedades de Obstetricia y Ginecología (FLASOG)
| | | | - Ana Isabel Gómez
- Sociedad Española de Senología y Patología Mamaria (SESPM), Spain
| | - Mª Ángeles Gómez
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Silvia González
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | | | | | - Sonia Herrero
- Sociedad Española de Trombosis y Hemostasia (SETH), Spain
| | - Eva Iglesias
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Ana Rosa Jurado
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Spain
| | - Iñaki Lete
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Daniel Lubián
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | - Aníbal Nieto
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Laura Nieto
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | | | | | | | - Jesús Presa
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | - Miriam Ribes
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Pablo Romero
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Beatriz Roca
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | | | | | | | | | | | - Joaquín Calaf
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
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Einfluss einer Hormonersatztherapie in der Peri- und Postmenopause auf das Krebsrisiko. GYNAKOLOGISCHE ENDOKRINOLOGIE 2022. [DOI: 10.1007/s10304-022-00460-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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24
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Marsden J. The British menopause society consensus statement on the management of oestrogen deficiency symptoms, arthralgia and menopause diagnosis in women with treated for early breast cancer. Post Reprod Health 2022; 28:199-210. [PMID: 36050892 DOI: 10.1177/20533691221122358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This guidance document by the British Menopause Society provides an overview of the management of women experiencing oestrogen deficiency symptoms and arthralgia following a breast cancer diagnosis. It is now recommended breast cancer patients are referred to health care professionals with an expertise in menopause for management of such symptoms, which in turn often involves liaison with patients' breast cancer teams.1 However, as many women initially present to primary health care professionals for advice, this statement is aimed to support the latter in such consultations by providing information about symptom aetiology, current management strategies and controversies and identifying useful practice points. This is an updated version of the 2018 consensus statement prepared by Miss Jo Marsden Consultant Breast Surgeon, King's College Hospital, London, (retired), Mr Mike Marsh, Consultant Gynae-endocrinologist, King's College Hospital, London, Dr Anne Rigg, Consultant Medical Oncologist, Guy's and St Thomas' Hospital, London.
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Affiliation(s)
- Jo Marsden
- 8948King's College Hospital NHS Foundation Trust, London, UK
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25
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Stettler S, Aebi S. [Endocrine Treatments in Breast Cancer]. PRAXIS 2022; 111:550-556. [PMID: 35920011 DOI: 10.1024/1661-8157/a003878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Endocrine Treatments in Breast Cancer Abstract. Breast cancer, the most common cancer in women, expresses estrogen and/or progesterone receptors in about 75% of patients. This allows for the use of endocrine treatments. Adjuvant therapy with tamoxifen for 5 years reduces the mortality by about 33%; the residual risk can be lowered by using aromatase inhibitors and by prolonging the treatment. In patients with advanced disease, the median duration of response to first-line therapy is about twelve months, and the median survival time is 20 to 40 months. The use of the various substances differs in terms of duration, sequence, and combinations, particularly with CDK4/6-inhibitors, depending on the clinical situation. Endocrine therapies are prescribed over a long period of time. Treatment adherence is improved by optimal control of side effects.
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Affiliation(s)
- Sonja Stettler
- Tumorzentrum LUKS, Medizinische Onkologie, Luzerner Kantonsspital, Luzern, Schweiz
| | - Stefan Aebi
- Tumorzentrum LUKS, Medizinische Onkologie, Luzerner Kantonsspital, Luzern, Schweiz
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Poggio F, Ceppi M, Fregatti P, Lambertini M, Tagliamento M. Comment on "Safety of systemic hormone replacement therapy in breast cancer survivors: a systematic review and meta‑analysis". Breast Cancer Res Treat 2022; 194:709-710. [PMID: 35739368 DOI: 10.1007/s10549-022-06590-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/27/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Francesca Poggio
- Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Piero Fregatti
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genova, Genova, Italy
- Breast Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - Marco Tagliamento
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
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27
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Baek JK, Kim HI, Kang MJ, Seon KE, Kim EH, Seo SK. Relationship between the type of hormone replacement therapy and incidence of breast cancer in Korea. Climacteric 2022; 25:516-522. [PMID: 35674251 DOI: 10.1080/13697137.2022.2077096] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study aimed to investigate the relationship between hormone replacement therapy (HRT) types and breast cancer (BC) incidence in postmenopausal women in Korea. METHODS The nested case-control study used data from the National Health Insurance Service database. Among the women aged ≥50 years who menopaused between 2004 and 2007, BC incidence up to 2017 was analyzed in 36,446 women using or having used HRT for >1 year and in 36,446 women who did not use any HRT for more than 1 year. HRT types and duration were classified into three categories. RESULTS BC risk (BCR) decreased with tibolone use for all ages. With HRT initiation in women aged ≥50 years, BCR was lower with tibolone and estrogen-progestogen therapy. HRT for <3 years showed lower BCR with tibolone, while higher BCR was observed with estrogen-only therapy. BCR was lower in women of all ages on HRT for >5 years than in the control group. CONCLUSIONS For women in their 50s, tibolone use lowers BCR; for all ages, the use of any HRT for >5 years showed lower BCR in Korea. These divergent results from western countries could be associated with the specific characteristics of BC in Korea.
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Affiliation(s)
- J K Baek
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - H I Kim
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - M J Kang
- Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - K E Seon
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - E H Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - S K Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Abstract
ABSTRACT This article reviews the decades of evidence supporting the reproducible benefits of HRT for menopausal symptom control, improved cardiac health, prevention of hip fracture, reduction in the risk and pace of cognitive decline, and enhanced longevity. It quantifies the increased risk of thromboembolism associated with oral, though not transdermal, HRT. It evaluates the repeated claims that HRT is associated with an increased risk of breast cancer development, and, when administered to breast cancer survivors, an increased risk of breast cancer recurrence. Twenty-five studies of HRT after a breast cancer diagnosis, published between 1980 and 2013, are discussed, as are the 20 reviews of those studies published between 1994 and 2021. Only 1 of the 25 studies, the HABITS trial, demonstrated an increased risk of recurrence, which was limited to local or contralateral, and not distant, recurrence. None of the studies, including HABITS, reported increased breast cancer mortality associated with HRT. Even in the HABITS trial, the absolute increase in the number of women who had a recurrence (localized only) associated with HRT administration was 22. It is on the basis of these 22 patients that HRT, with its demonstrated benefits for so many aspects of women's health, is being denied to millions of breast cancer survivors around the world.
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Lubián López DM. Management of genitourinary syndrome of menopause in breast cancer survivors: An update. World J Clin Oncol 2022; 13:71-100. [PMID: 35316932 PMCID: PMC8894268 DOI: 10.5306/wjco.v13.i2.71] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/19/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
There is increasing attention about managing the adverse effects of adjuvant therapy (Chemotherapy and anti-estrogen treatment) for breast cancer survivors (BCSs). Vulvovaginal atrophy (VVA), caused by decreased levels of circulating estrogen to urogenital receptors, is commonly experienced by this patients. Women receiving antiestrogen therapy, specifically aromatase inhibitors, often suffer from vaginal dryness, itching, irritation, dyspareunia, and dysuria, collectively known as genitourinary syndrome of menopause (GSM), that it can in turn lead to pain, discomfort, impairment of sexual function and negatively impact on multiple domains of quality of life (QoL). The worsening of QoL in these patients due to GSM symptoms can lead to discontinuation of hormone adjuvant therapies and therefore must be addressed properly. The diagnosis of VVA is confirmed through patient-reported symptoms and gynecological examination of external structures, introitus, and vaginal mucosa. Systemic estrogen treatment is contraindicated in BCSs. In these patients, GSM may be prevented, reduced and managed in most cases but this requires early recognition and appropriate treatment, but it is normally undertreated by oncologists because of fear of cancer recurrence, specifically when considering treatment with vaginal estrogen therapy (VET) because of unknown levels of systemic absorption of estradiol. Lifestyle modifications and nonhormonal treatments (vaginal moisturizers, lubricants, and gels) are the first-line treatment for GSM both in healthy women as BCSs, but when these are not effective for symptom relief, other options can be considered, such as VET, ospemifene, local androgens, intravaginal dehydroepiandrosterone (prasterone), or laser therapy (erbium or CO2 Laser). The present data suggest that these therapies are effective for VVA in BCSs; however, safety remains controversial and a there is a major concern with all of these treatments. We review current evidence for various nonpharmacologic and pharmacologic therapeutic modalities for GSM in BCSs and highlight the substantial gaps in the evidence for safe and effective therapies and the need for future research. We include recommendations for an approach to the management of GSM in women at high risk for breast cancer, women with estrogen-receptor positive breast cancers, women with triple-negative breast cancers, and women with metastatic disease.
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Affiliation(s)
- Daniel María Lubián López
- Department of Mother and Child Health and Radiology, Faculty of Medicine, University of Cadiz, Cádiz 11100, Spain
- Department of Obstetrics and Gynecology Service, University Hospital of Jerez de la Frontera, Jerez de la Frontera 11407, Spain
- Department of Obstetrics and Gynecology, Hospital Viamed Bahía de Cádiz, Chiclana de la Frontera 11130, Cádiz, a Spain
- Department of Obstetrics and Gynecology, Hospital Quirónsalud Campo de Gibraltar, Los Barrios 11379, Cádiz, Spain
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30
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Bluming AZ. Safety of systemic hormone replacement therapy in breast cancer survivors. Breast Cancer Res Treat 2022; 191:685-686. [PMID: 34993765 DOI: 10.1007/s10549-021-06479-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 11/27/2022]
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Poggio F, Del Mastro L, Bruzzone M, Ceppi M, Razeti MG, Fregatti P, Ruelle T, Pronzato P, Massarotti C, Franzoi MA, Lambertini M, Tagliamento M. Safety of systemic hormone replacement therapy in breast cancer survivors: a systematic review and meta-analysis. Breast Cancer Res Treat 2021; 191:269-275. [PMID: 34731351 DOI: 10.1007/s10549-021-06436-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Symptoms of treatment-induced menopause negatively affect quality of life and adherence to endocrine therapy of breast cancer (BC) survivors. Nevertheless, the use of systemic hormone replacement therapy (HRT) to mitigate these symptoms may be associated with an increased risk of disease recurrence in these patients. This systematic review and meta-analysis aimed to assess the safety of systemic HRT on risk of disease recurrence in BC survivors. METHODS A systematic search of PubMed up to April 20, 2021 was conducted to identify randomized controlled trials (RCTs) that investigated the risk of disease recurrence with the use of HRT in BC survivors. A random-effect model was applied to calculate the risk of recurrence, reported as pooled hazard ratio (HR) with 95% confidence intervals (CI). A subgroup analysis was performed to estimate the risk of recurrence according to hormone receptor status. RESULTS Four RCTs were included in the meta-analysis (n = 4050 patients). Overall, 2022 patients were randomized to receive HRT (estrogen/progestogen combination or tibolone) and 2023 to the control group with placebo or no HRT. HRT significantly increased the risk of BC recurrence compared to placebo (HR 1.46, 95% CI 1.12-1.91, p = 0.006). At the subgroup analysis, the risk of BC recurrence with the use of HRT was significantly increased in patients with hormone receptor-positive disease (HR 1.8, 95% CI 1.15-2.82, p = 0.010) but not in those with hormone receptor-negative tumors (HR 1.19, 95% CI 0.80-1.77, p = 0.390). CONCLUSION Use of HRT was associated with a detrimental prognostic effect in BC survivors, particularly in those with hormone receptor-positive disease. Alternative interventions to mitigate menopause-related symptoms should be proposed.
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Affiliation(s)
- Francesca Poggio
- Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lucia Del Mastro
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genova, Italy
| | - Marco Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Grazia Razeti
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Piero Fregatti
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genova, Genova, Italy.,Breast Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Tommaso Ruelle
- Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Paolo Pronzato
- Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Claudia Massarotti
- Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genova, Italy. .,U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - Marco Tagliamento
- Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genova, Italy
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Yuksel N, Evaniuk D, Huang L, Malhotra U, Blake J, Wolfman W, Fortier M. Directive clinique n o 422a : Ménopause : symptômes vasomoteurs, agents thérapeutiques d'ordonnance, médecines douces et complémentaires, nutrition et mode de vie. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1205-1223.e1. [PMID: 34649685 DOI: 10.1016/j.jogc.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIF Proposer des stratégies pour améliorer les soins aux femmes ménopausées ou en périménopause d'après les plus récentes données probantes publiées. POPULATION CIBLE Femmes ménopausées ou en périménopause. BéNéFICES, RISQUES ET COûTS: La population cible bénéficiera des plus récentes données scientifiques publiées que leur communiqueront les fournisseurs de soins de santé. Aucun coût ni préjudice ne sont associés à cette information, car les femmes seront libres de choisir parmi les différentes options thérapeutiques offertes pour la prise en charge des symptômes et morbidités associés à la ménopause, y compris l'abstention thérapeutique. DONNéES PROBANTES: Les auteurs ont interrogé les bases de données PubMed, Medline et Cochrane Library pour extraire des articles publiés entre 2002 et 2020 en utilisant des termes MeSH spécifiques à chacun des sujets abordés dans les 7 chapitres. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique d'évaluation, de développement et d'évaluation (GRADE). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: médecins, y compris gynécologues, obstétriciens, médecins de famille, internistes, urgentologues; infirmières, y compris infirmières autorisées et infirmières praticiennes; pharmaciens; stagiaires, y compris étudiants en médecine, résidents, moniteurs cliniques; et autres fournisseurs de soins auprès de la population cible. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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Yuksel N, Evaniuk D, Huang L, Malhotra U, Blake J, Wolfman W, Fortier M. Guideline No. 422a: Menopause: Vasomotor Symptoms, Prescription Therapeutic Agents, Complementary and Alternative Medicine, Nutrition, and Lifestyle. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1188-1204.e1. [PMID: 34390867 DOI: 10.1016/j.jogc.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Provide strategies for improving the care of perimenopausal and postmenopausal women based on the most recent published evidence. TARGET POPULATION Perimenopausal and postmenopausal women. BENEFITS, HARMS, AND COSTS Target population will benefit from the most recent published scientific evidence provided via the information from their health care provider. No harms or costs are involved with this information since women will have the opportunity to choose among the different therapeutic options for the management of the symptoms and morbidities associated with menopause, including the option to choose no treatment. EVIDENCE Databases consulted were PubMed, MEDLINE, and the Cochrane Library for the years 2002-2020, and MeSH search terms were specific for each topic developed through the 7 chapters. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE: physicians, including gynaecologists, obstetricians, family physicians, internists, emergency medicine specialists; nurses, including registered nurses and nurse practitioners; pharmacists; medical trainees, including medical students, residents, fellows; and other providers of health care for the target population. SUMMARY STATEMENTS RECOMMENDATIONS.
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Menopausal hormone therapy: Characterising users in an Australian national cross-sectional study. PLoS One 2021; 16:e0253725. [PMID: 34379634 PMCID: PMC8357145 DOI: 10.1371/journal.pone.0253725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/05/2021] [Indexed: 11/19/2022] Open
Abstract
Menopausal hormone therapy (MHT) is effective for menopausal symptoms, however, its use is also associated with risks of serious health conditions including breast, ovarian and endometrial cancer, stroke and venous thromboembolism. MHT-related health risks increase with longer durations of use. In Australia, while overall MHT use fell when risk-related findings were published in 2002, a significant number of women continue using MHT long-term. We aimed to examine socio-demographic, health-related and lifestyle characteristics in relation to post-2002 MHT use, and to compare use for <5 and ≥5 years. Data from 1,561 participants from an Australian, national, cross-sectional survey of women aged 50–69 in 2013 were analysed. Odds ratios (ORs) were calculated using logistic regression for characteristics related to overall MHT use post-2002 and multinomial logistic regression for associations between MHT duration of use [never/<5 years/≥5 years] and personal characteristics, adjusting for sociodemographic, reproductive, health and lifestyle factors. Post-2002 MHT use was associated with increasing age (p-trend<0.001), hysterectomy versus no hysterectomy (OR:2.55, 95%CI = 1.85–3.51), bilateral oophorectomy vs no oophorectomy (OR:1.66, 95%CI = 1.09–2.53), and ever- versus never-use of therapies other than MHT for menopausal symptoms (OR:1.93, 95%CI = 1.48–2.57). Women with prior breast cancer (OR:0.35, 95%CI = 0.17–0.74) and with more children (p-trend = 0.034) were less likely than other women to use MHT. Prior hysterectomy was more strongly associated with MHT use for ≥5 years than for <5 years (p = 0.004). Ever-use of non-MHT menopausal therapies was associated with MHT use for <5 years but not with longer-term use (p = 0.004). This study reinforces the need for MHT users and their clinicians to re-evaluate continued MHT use on an ongoing basis.
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van Barele M, Heemskerk-Gerritsen BAM, Louwers YV, Vastbinder MB, Martens JWM, Hooning MJ, Jager A. Estrogens and Progestogens in Triple Negative Breast Cancer: Do They Harm? Cancers (Basel) 2021; 13:2506. [PMID: 34063736 PMCID: PMC8196589 DOI: 10.3390/cancers13112506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/29/2021] [Accepted: 05/17/2021] [Indexed: 12/31/2022] Open
Abstract
Triple-negative breast cancers (TNBC) occur more frequently in younger women and do not express estrogen receptor (ER) nor progesterone receptor (PR), and are therefore often considered hormone-insensitive. Treatment of premenopausal TNBC patients almost always includes chemotherapy, which may lead to premature ovarian insufficiency (POI) and can severely impact quality of life. Hormone replacement therapy (HRT) is contraindicated for patients with a history of hormone-sensitive breast cancer, but the data on safety for TNBC patients is inconclusive, with a few randomized trials showing increased risk-ratios with wide confidence intervals for recurrence after HRT. Here, we review the literature on alternative pathways from the classical ER/PR. We find that for both estrogens and progestogens, potential alternatives exist for exerting their effects on TNBC, ranging from receptor conversion, to alternative receptors capable of binding estrogens, as well as paracrine pathways, such as RANK/RANKL, which can cause progestogens to indirectly stimulate growth and metastasis of TNBC. Finally, HRT may also influence other hormones, such as androgens, and their effects on TNBCs expressing androgen receptors (AR). Concluding, the assumption that TNBC is completely hormone-insensitive is incorrect. However, the direction of the effects of the alternative pathways is not always clear, and will need to be investigated further.
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Affiliation(s)
- Mark van Barele
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.v.B.); (B.A.M.H.-G.); (J.W.M.M.); (M.J.H.)
| | - Bernadette A. M. Heemskerk-Gerritsen
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.v.B.); (B.A.M.H.-G.); (J.W.M.M.); (M.J.H.)
| | - Yvonne V. Louwers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands;
| | - Mijntje B. Vastbinder
- Department of Internal Medicine, Ijsselland Hospital, Prins Constantijnweg 2, 2906 ZC Capelle aan den IJssel, The Netherlands;
| | - John W. M. Martens
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.v.B.); (B.A.M.H.-G.); (J.W.M.M.); (M.J.H.)
| | - Maartje J. Hooning
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.v.B.); (B.A.M.H.-G.); (J.W.M.M.); (M.J.H.)
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.v.B.); (B.A.M.H.-G.); (J.W.M.M.); (M.J.H.)
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Gosset A, Robin G, Letombe B, Pouillès JM, Trémollieres F. [Menopause hormone treatment in practice. Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:358-372. [PMID: 33757922 DOI: 10.1016/j.gofs.2021.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Menopause Hormonal Treatment (MHT) was initially developed to correct the climacteric symptoms induced by postmenopausal estrogen deficiency. In non-hysterectomized women, MHT combines estrogens and a progestogen, the latter opposing the negative impact of estrogen on endometrial proliferation. In France, and contrary to the USA and Northern European countries, MHT mainly combines 17β-estradiol, which is the physiological estrogen produced by the ovary, and progesterone or its derivative, dihydrogesterone. France has been a pioneer in the development of cutaneous administration routes (gel or transdermal patch) for estradiol, allowing better metabolic tolerance and a reduction of the risk of venous thromboembolism compared to the oral route. The choice of the doses as well as the treatment regimen is underpinned by tolerance as well as acceptance and compliance. The risk of breast cancer, which is one of the main risks of MHT, is higher with estro-progestogen combinations than with estrogens alone ; the preferential use of progesterone or dihydrogesterone being likely to limit the excess risk of breast cancer associated with MHT at least for duration of treatment of less than 5 to 7 years. The question of the optimal duration of MHT remains an issue and must take into account the initial indication of treatment as well as the benefit-risk balance, which is specific to each woman. Continuation of MHT is conditioned by the benefit-risk balance, which must be evaluated regularly, but also by the evolution of symptoms when MHT is stopped as well as menopause-related health risks or induced by MHT. After stopping MHT, it is necessary to maintain a medical follow-up to be adapted to the clinical situation of each woman and in particular, her cardiovascular and gynecological risk factors.
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Affiliation(s)
- A Gosset
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France
| | - G Robin
- Service de gynécologie médicale, orthogénie et sexologie-UF de gynécologie endocrinienne, CHU Jeanne-de-Flandres, Lille, France
| | - B Letombe
- Service de gynécologie médicale, orthogénie et sexologie-UF de gynécologie endocrinienne, CHU Jeanne-de-Flandres, Lille, France
| | - J-M Pouillès
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France
| | - F Trémollieres
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France; Inserm U1048-I2MC-équipe 9, université Toulouse III Paul-Sabatier, Toulouse, France.
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Franzoi MA, Agostinetto E, Perachino M, Del Mastro L, de Azambuja E, Vaz-Luis I, Partridge AH, Lambertini M. Evidence-based approaches for the management of side-effects of adjuvant endocrine therapy in patients with breast cancer. Lancet Oncol 2021; 22:e303-e313. [PMID: 33891888 DOI: 10.1016/s1470-2045(20)30666-5] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/13/2020] [Accepted: 10/22/2020] [Indexed: 12/13/2022]
Abstract
The growing availability of more effective therapies has contributed to an increased survival of patients with breast cancer. In hormone receptor-positive early disease, increased survival is strongly correlated with the use of adjuvant endocrine therapy, but this therapy can cause side-effects that have major consequences in terms of treatment adherence and patients' quality of life. In premenopausal breast cancer survivors, these side-effects might be even more prominent due to the abrupt suppression of oestrogen associated with the most intense endocrine therapies. An important ambition of cancer care in the 21st century is to recover pre-cancer quality of life and emotional and social functions, which is only possible through the mitigation of the side-effects of anticancer treatments. This Review presents a comprehensive summary of the efficacy and safety data of the available interventions (hormonal and non-hormonal pharmacological strategies, non-pharmacological approaches, and complementary and alternative medicine) to control selected side-effects associated with adjuvant endocrine therapy (hot flashes, sexual dysfunction, weight gain, musculoskeletal symptoms, and fatigue), providing updated, evidence-based approaches for their management.
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Affiliation(s)
- Maria Alice Franzoi
- Academic Trials Promoting Team, Jules Bordet Institute and Université Libre de Bruxelles, Brussels, Belgium
| | - Elisa Agostinetto
- Academic Trials Promoting Team, Jules Bordet Institute and Université Libre de Bruxelles, Brussels, Belgium; Medical Oncology and Hematology Unit, IRCCS Istituto Clinico Humanitas-Humanitas Cancer Center, Humanitas Research Hospital, Milan, Italy
| | - Marta Perachino
- Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy; Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa, Italy; Breast Unit, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Evandro de Azambuja
- Academic Trials Promoting Team, Jules Bordet Institute and Université Libre de Bruxelles, Brussels, Belgium
| | - Ines Vaz-Luis
- Unit 981-Molecular Predictors and New Targets In Oncology, Department of Medical Oncology, INSERM and Institut Gustave Roussy, Paris, France
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Matteo Lambertini
- Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy; Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa, Italy.
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Chakrabarti R, Holloway D, Bruce D, Rymer J. The management of menopausal symptoms in women following treatment for cancer at a specialist menopause service. Post Reprod Health 2021; 27:137-144. [PMID: 33823682 DOI: 10.1177/20533691211000548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to identify prescribing patterns at a specialist menopause service in a central London teaching hospital for women following treatment for a malignancy. STUDY DESIGN This was a prospective cohort study with data collected over a seven-month period from December 2019 to June 2020. All women reviewed at the specialist menopause services following treatment of a malignancy, BRCA carriers and Lynch syndrome were included in the study, with management options divided into three categories: hormonal, non-hormonal and no treatment. MAIN OUTCOME MEASURES The primary outcome of this study was to identify prescribing patterns for all women reviewed following a diagnosis of a malignancy, as well as those with genetic mutations necessitating risk-reducing prophylactic bilateral salpingo-oopherectomy (BSO). RESULTS Altogether 71 women were included in this study, with the majority of women post management of a non-gynaecological malignancy (51/71, 72%), of which breast cancer was the most common (37/71, 52%). While non-hormonal treatment was the most popular among those treated for breast cancer, for all other malignancies, hormonal treatment was more widespread. Fourteen women also had genetic mutations, with all of these women commencing hormonal treatment post risk reducing surgery. CONCLUSION With the exception of those with a history of hormone-sensitive breast cancer, the use of hormonal treatment for menopausal symptoms remained widespread. While this was a relatively small study, the need for long-term follow-up across specialist menopause services, to assess the risk of recurrence is vital.
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Affiliation(s)
| | | | - D Bruce
- King's College London, London, UK
| | - J Rymer
- King's College London, London, UK
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Ugras SK, Layeequr Rahman R. Hormone replacement therapy after breast cancer: Yes, No or maybe? Mol Cell Endocrinol 2021; 525:111180. [PMID: 33508379 DOI: 10.1016/j.mce.2021.111180] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/13/2021] [Accepted: 01/21/2021] [Indexed: 01/16/2023]
Abstract
Over nine million breast cancer survivors worldwide suffer compromised quality of life attributable to estrogen depletion related symptoms of menopause and side effects of cancer therapy. Hormone Replacement Therapy (HRT) is very effective in managing these symptoms in general population and in breast cancer survivors. However, the concern of breast cancer recurrence as a result of HRT use keeps many oncologists from using this approach in symptom management. Evidence from randomized trials, observational studies and met-analyses on the impact of HRT use on breast cancer recurrence and survival remains controversial. Climacteric symptoms in breast cancer survivors should be delineated for type and severity for methodical management. Lifestyle modifications are effective for mild symptoms, while non-hormonal pharmaceutical approaches can be used as second-line therapy for control of hot flashes, vulvo-vaginal atrophy, arthralgia, mood swings, sleep disturbance, and depression. Evidence does not conclusively render HRT, as a contraindicated approach for these patients; informed consent and shared-decision-making is a reasonable approach for HRT use in symptomatic breast cancer survivors.
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Affiliation(s)
- Stacy K Ugras
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
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Kauffman RP, Young C, Castracane VD. Perils of prolonged ovarian suppression and hypoestrogenism in the treatment of breast cancer: Is the risk of treatment worse than the risk of recurrence? Mol Cell Endocrinol 2021; 525:111181. [PMID: 33529690 DOI: 10.1016/j.mce.2021.111181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/04/2021] [Accepted: 01/21/2021] [Indexed: 01/18/2023]
Abstract
Premenopausal breast cancer is usually estrogen receptor positive, and hence, prolonged ovarian suppression by medical or surgical means to prevent recurrence has become standard of management to improve disease-free survival. Ten-year adjuvant tamoxifen therapy is associated with 3.5% fewer recurrences compared to five years. The SOFT trial demonstrated small but statistically significant incremental improvements in long-term disease-free survival by the addition of gonadotropin-releasing hormone analog treatment (triptorelin) to an aromatase inhibitor (exemestane). Profound hypoestrogenism in the premenopausal age group may not be well tolerated due to a host of bothersome side effects (primarily vasomotor symptoms, musculoskeletal complaints, genitourinary syndrome of menopause, and mood disorders). Prolonged hypoestrogenism in younger women is associated with premature development of cardiovascular disease, bone loss, cognitive decline, and all-cause mortality. This paper explores multi-system consequences of prolonged hypoestrogenism in premenopausal women derived from studies of women with and without breast cancer. Pretreatment counseling in estrogen receptor positive breast cancer should emphasize the benefit of prolonged estrogen suppression on breast cancer recurrence and established risks of lifelong hypoestrogenism on quality of life and all-cause mortality. Future genomic research may help identify the best candidates for extended ovarian suppression to avoid treating many women when only a minority benefit.
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Affiliation(s)
- Robert P Kauffman
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, School of Medicine, 1400 S. Coulter Rd, Amarillo, TX, 79106, USA.
| | - Christina Young
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, School of Medicine, 1400 S. Coulter Rd, Amarillo, TX, 79106, USA
| | - V Daniel Castracane
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, School of Medicine, 1400 S. Coulter Rd, Amarillo, TX, 79106, USA
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Peate M, Saunders C, Cohen P, Hickey M. Who is managing menopausal symptoms, sexual problems, mood and sleep disturbance after breast cancer and is it working? Findings from a large community-based survey of breast cancer survivors. Breast Cancer Res Treat 2021; 187:427-435. [PMID: 33575860 DOI: 10.1007/s10549-021-06117-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/21/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To determine the nature and severity of vasomotor symptoms, sexual problems, mood and sleep disturbance in community-dwelling breast cancer patients, whether and where they received treatment for these symptoms and their satisfaction with treatment received. METHODS Online cross-sectional survey distributed through Breast Cancer Network Australia (BCNA). RESULTS 524/2286 women responded to the invitation to participate. Of these, 74% (385/523) reported symptoms of interest and were included in the analysis. Mean age was 55.2 years and mean time since breast cancer diagnosis was 5.7 years. Most (66%) had received chemotherapy and were taking endocrine therapy (64%). The most common symptoms were hot flushes/night sweats and sleep disturbance (both 89%), vaginal dryness (75%), mood swings (62%) and sexual problems (60%). Symptoms were mild (21-33%) or moderate (21-38%) in around one third and severe in up to one quarter (8-26%). Symptoms affected the ability to "get on with their life" for 36%, predicted by severity of hot flushes (OR 1.4), sleep disturbance (OR 1.3), mood disturbance (OR 1.3), and sexual problems (OR 1.3). Only 32% were offered treatment, mostly delivered by GPs (33%) or oncologists (26%). Only 49% found this "somewhat effective" and 34% found it ineffective. The majority (60%) wanted more support to manage their symptoms. CONCLUSION Menopausal symptoms, sexual problems, mood and sleep difficulties are common after breast cancer and often not effectively managed. There is an unmet need for coordinated care providing effective treatments.
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Affiliation(s)
- Michelle Peate
- Department of Obstetrics & Gynaecology, University of Melbourne, Level 7, Royal Women's Hospital, 20 Flemington Road, Parkville, VIC, 3052, Australia.
| | - Christobel Saunders
- Division of Surgery, Faculty of Health and Medical Sciences, University of Western Australia School of Surgery, Murdoch, WA, 6150, Australia
| | - Paul Cohen
- Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, WA, 6009, Australia
| | - Martha Hickey
- Department of Obstetrics & Gynaecology, University of Melbourne, Level 7, Royal Women's Hospital, 20 Flemington Road, Parkville, VIC, 3052, Australia
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Mendoza N, Carrión R, Mendoza-Huertas L, Jurado AR. Efficacy and Safety of Treatments to Improve Dyspareunia in Breast Cancer Survivors: A Systematic Review. Breast Care (Basel) 2021; 15:599-607. [PMID: 33447234 DOI: 10.1159/000506148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/27/2020] [Indexed: 12/23/2022] Open
Abstract
Objective To analyse all available evidence to validate the effectiveness of a local intervention in the treatment of dyspareunia in breast cancer survivors (BCS). Methods We searched the Institute of Scientific Information Web of Knowledge, MEDLINE, PubMed, Scopus, and Cochrane databases for all articles published in peer-reviewed journals up to April 2019. The PICOS standards were: (population) BCS with dyspareunia; (intervention) any type of vulvovaginal treatment; (main outcome) frequency and severity of dyspareunia; (study design) clinical studies. Results The literature search strategy identified 252 articles, of which 233 were excluded at various stages of the search. Finally, we systematically reviewed 19 studies, 8 with local hormonal therapies, 7 with local non-hormonal therapies, 3 with laser therapy, and 1 with other interventions. Of the studies, 7 were randomized control trials and 11 were prospective observations. Most of the interventions were shown to be effective and safe in the improvement of dyspareunia. Conclusion In addition to the traditional options already analysed in other current reviews, other interesting options are highlighted (such as laser or local dehydroepiandrosterone [DHEA]). Further work on dyspareunia should make use of high-quality trials with large numbers of samples to obtain evidence that could adequately demonstrate key methodological characteristics and harmful effects.
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Affiliation(s)
- Nicolás Mendoza
- Departamento de Obstetricia y Ginecología, Universidad de Granada, Granada, Spain
| | - Rosalía Carrión
- Departamento de Obstetricia y Ginecología, Universidad de Granada, Granada, Spain
| | | | - Ana Rosa Jurado
- Departamento de Obstetricia y Ginecología, Universidad de Granada, Granada, Spain.,Instituto Europeo de Sexologia, Marbella, Spain
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Hormonal management of menopausal symptoms in women with a history of gynecologic malignancy. ACTA ACUST UNITED AC 2020; 27:243-248. [PMID: 31738735 DOI: 10.1097/gme.0000000000001447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The aim of the study was to review the role of hormone therapy in menopausal patients with breast cancer and gynecologic malignancies. METHODS We searched MEDLINE (via PubMed) using a combination of keywords and database-specific subject headings for the following concepts: menopause, hormone therapy, and cancer. Editorials, letters, case reports, and comments were excluded, as were non-English articles. Additional references were identified by hand-searching bibliographies of included articles. The searches yielded a total of 1,484 citations. All citations were imported into EndNote X9, where they were screened by the authors. RESULTS In breast cancer survivors, systemic hormone therapy is not recommended, whereas local low-dose estrogen therapy may be considered after discussion with the patient's oncologist. Among endometrial cancer survivors, hormone therapy is considered safe in low-risk cancers but should be avoided in high-risk subtypes. For survivors of epithelial ovarian cancer and cervical cancer, hormone therapy can be considered, but should be avoided in women with estrogen-sensitive histologic subtypes. CONCLUSIONS The risks of hormone therapy should be assessed on an individual basis, with consideration of age, type of hormone therapy, dose, duration of use, regimen, route, and prior exposure. Systemic hormone therapy is not recommended in breast cancer survivors, whereas vaginal low-dose estrogen appears safe. Hormone therapy may be used by endometrial, cervical, and ovarian cancer survivors with low-risk, non-estrogen-receptor-positive subtypes. Video Summary: http://links.lww.com/MENO/A516.
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Del Río JP, Molina S, Hidalgo-Lanussa O, Garcia-Segura LM, Barreto GE. Tibolone as Hormonal Therapy and Neuroprotective Agent. Trends Endocrinol Metab 2020; 31:742-759. [PMID: 32507541 DOI: 10.1016/j.tem.2020.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022]
Abstract
Tibolone (TIB), a selective tissue estrogenic activity regulator (STEAR) in clinical use by postmenopausal women, activates hormonal receptors in a tissue-specific manner. Estrogenic activity is present mostly in the brain, vagina, and bone, while the inactive forms predominate in the endometrium and breast. Conflicting literature on TIB's actions has been observed. While it has benefits for vasomotor symptoms, bone demineralization, and sexual health, a higher relative risk of hormone-sensitive cancer has been reported. In the brain, TIB can improve mood and cognition, neuroinflammation, and reactive gliosis. This review aims to discuss the systemic effects of TIB on peri- and post-menopausal women and its role in the brain. We suggest that TIB is a hormonal therapy with promising neuroprotective properties.
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Affiliation(s)
- Juan Pablo Del Río
- Reproductive Health Research Institute, Santiago, Chile; Translational Psychiatry Laboratory, Clínica Psiquiátrica Universitaria, Hospital Clínico, Universidad de Chile, Santiago, Chile; Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
| | | | - Oscar Hidalgo-Lanussa
- Departamento de Nutrición y Bioquímica, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Luis Miguel Garcia-Segura
- Instituto Cajal, CSIC, Madrid, Spain; Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - George E Barreto
- Department of Biological Sciences, School of Natural Sciences, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland.
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Marsden J, Pedder H. The risks and benefits of hormone replacement therapy before and after a breast cancer diagnosis. Post Reprod Health 2020; 26:126-135. [PMID: 32997592 DOI: 10.1177/2053369120956636] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Jo Marsden
- Medical Advisory Council, The British Menopause Society, UK
| | - Hugo Pedder
- Statistical Modelling, University of Bristol, UK
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Marsh S, Borges VF, Coons HL, Afghahi A. Sexual health after a breast cancer diagnosis in young women: clinical implications for patients and providers. Breast Cancer Res Treat 2020; 184:655-663. [PMID: 32968951 DOI: 10.1007/s10549-020-05880-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/13/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Sexual dissatisfaction after breast cancer treatment is a common phenomenon that, unfortunately, places a significant strain on young women and is becoming more common as treatment regimens rely more and more on anti-endocrine therapies. METHODS A PubMed review of peer reviewed manuscripts between the years 1998-2020 evaluating sexual health and wellbeing in cancer patients, primarily young women with breast cancer, was conducted. RESULTS There are several categories of sexual dissatisfaction women may experience as a result of her breast cancer diagnosis, including menopausal symptoms and dyspareunia, negative body image, reduced sexual desire, strained relationships and partner communication, and anxiety about cancer disclosure in dating relationships. Several methods of addressing each domain have been studied. While hormonal replacement therapy remains controversial, other medication regimens have been shown to be effective in treating menopausal symptoms and dyspareunia. Cognitive behavioral therapy, sex therapy, and couples' therapy are all effective in addressing a variety of symptoms across multiple domains. CONCLUSIONS Oncologists are often not prepared to discuss sexual health concerns as frequently as women need. Further work is needed to bring easily digestible and meaningful educational opportunities into clinical practice so young breast cancer survivors can receive comprehensive post-cancer survivorship care.
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Affiliation(s)
- Sydney Marsh
- University of Colorado Cancer Center, Aurora, CO, USA
| | | | - Helen L Coons
- University of Colorado Cancer Center, Aurora, CO, USA
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Ortmann O, Beckermann MJ, Inwald EC, Strowitzki T, Windler E, Tempfer C. Peri- and postmenopause-diagnosis and interventions interdisciplinary S3 guideline of the association of the scientific medical societies in Germany (AWMF 015/062): short version. Arch Gynecol Obstet 2020; 302:763-777. [PMID: 32661753 PMCID: PMC7447675 DOI: 10.1007/s00404-020-05682-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/04/2020] [Indexed: 10/29/2022]
Abstract
This short version of the interdisciplinary S3 guideline "Peri- and Postmenopause-Diagnosis and Interventions" is intended as a decision-making instrument for physicians who counsel peri- and postmenopausal women. It is designed to assist daily practice. The present short version summarizes the full version of the guideline which contains detailed information on guideline methodology, particularly regarding the critical appraisal of the evidence and the assignment of evidence levels. The statements and recommendations of the full version of the guideline are quoted completely in the present short version including levels of evidence (LoE) and grades of recommendation. The classification system developed by the Centre for Evidence-based Medicine in Oxford was used in this guideline.
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Affiliation(s)
- Olaf Ortmann
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany.
| | | | - Elisabeth C Inwald
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Thomas Strowitzki
- Department of Gynecological Endocrinology and Fertility Disorders, University Women's Hospital, Heidelberg, Germany
| | - Eberhard Windler
- Endocrinology and Metabolism of Ageing, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Clemens Tempfer
- Department of Obstetrics and Gynecology, Ruhr-University Bochum, Bochum, Germany
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Paschou SA, Augoulea A, Lambrinoudaki I. Bone health care in women with breast cancer. Hormones (Athens) 2020; 19:171-178. [PMID: 31853818 DOI: 10.1007/s42000-019-00164-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/03/2019] [Indexed: 01/09/2023]
Abstract
The aim of this article is to analyze and critically appraise the literature regarding optimal bone health care in women with breast cancer and, more specifically, to present (1) the causes of bone loss in breast cancer patients, (2) the appropriate screening for osteoporosis and fracture risk estimation, (3) optimal prevention and therapeutic strategies for osteoporosis and fractures, (4) the role of antiresorptive agents as adjuvant therapy for the prevention of bone metastases and increase of overall survival, and (5) current data on the possible use of menopausal hormone therapy (MHT) in these patients. The objective is to provide a sound pathophysiological background along with evidence-based and practical recommendations for physicians managing such women.
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Affiliation(s)
- Stavroula A Paschou
- Second Department of Obstetrics and Gynaecology, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Areti Augoulea
- Second Department of Obstetrics and Gynaecology, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynaecology, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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van Barele M, Heemskerk-Gerritsen BAM, van Doorn HC, Schmidt MK, Hooning MJ, Jager A. The impact of menstruation persistence or recovery after chemotherapy on survival in young patients with hormone receptor negative breast cancer. Breast 2020; 52:102-109. [PMID: 32497987 PMCID: PMC7375582 DOI: 10.1016/j.breast.2020.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Hormone 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. Methods We 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. Results Patients 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. Conclusion No 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. Menstruation often recovers after chemotherapy in young breast cancer patients. This is currently accepted for those with a hormone receptor negative subtype. The cell type such tumors arise from is possibly sensitive to paracrine stimulation. Recovery of menstruation may still negatively affect outcome in these patients.
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Affiliation(s)
- Mark van Barele
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | - Helena C van Doorn
- Department of Gynecological Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Marjanka K Schmidt
- Division of Molecular Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Epidemiology, Leiden University, Leiden, the Netherlands
| | - Maartje J Hooning
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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Ortmann O, Emons G, Tempfer C. Hormonersatztherapie nach hormonabhängigen Krebserkrankungen gemäß S3‑Leitlinie. GYNAKOLOGISCHE ENDOKRINOLOGIE 2020. [DOI: 10.1007/s10304-019-00296-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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