Abstract
Background and Objectives : Breast cancer is the most common cancer and the second cause of cancer deaths in the world population. The survival of patients who were diagnosed early with breast cancer prolongs with adjuvant cytotoxic treatments, however the occurrence of amenorrhea or menopause increases in these patients. The aim of this study was to assess the status of the chemotherapy related amenorrhea, using serum hormone levels and imaging methods. Also, the effects of two different chemotherapy regimens on these factors were compared.
Material and Methods: Forty five premenopausal women who were newly diagnosed with stage 1-3 breast cancer were enrolled in this study that was performed in Tabriz Gazi Hospital prospectively. Ultrasound examination and serum level concentration of Anti-Mulerian Hormone using elisa method were evaluated in all patients enrolled in the study, before and after adjuvant chemotherapy. Paired t-test or nonparametric equivalent of this test (Wilcoxon rank test) was used for analysis of dependent data and independent t-test or nonparametric equivalent of this test (Mann–Whitney U test) was used for analysis of independent data.
Results: Forty-five patients were enrolled in this study. Median age was 43 years old in the range 25-54 years. Eighteen patients (40%) received ECF (Epirubicin, Cyclophosphamide and Fluorouracil 5FU) chemotherapy regimen and 27 (60%) received AC-T (Adriamicin, Cyclophosphamide and Taxane) adjuvant chemotherapy regimen. The mean of AMH level before chemotherapy was 2.38± 0.65 ng/ml which was declined to 0.38±0.15 ng/ml after chemotherapy (P value<0.001). The size of ovary in ultrasonic examination was 9.03 cm and 10.91 in right and left side, respectively which were declined to 5.09 cm and 5.08 cm after chemotherapy (P value<0.001). There was a significant decrease in the number of follicle count in both right and left ovaries of subjects after chemotherapy (P value<0.05).
Conclusion: Both ultrasound indexes and AMH levels can be used to assess chemotherapy related amenorrhea in breast cancer patients. Serial evaluation of these factors is recommended to predict the menses status in these patients.