Sexual Dysfunction in Survivorship; the Impact of Menopause and Endocrine Therapy
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Sexual dysfunction is common for breast cancer survivors. Premenopausal women with breast cancer are increasingly offered ovarian suppression and aromatase inhibitor (AI) therapy. We evaluated the association of menopausal status and treatment modalities on sexual dysfunction.
We conducted a cross-sectional anonymous Female Sexual Function Index (FSFI) survey of breast cancer survivors between 2000 and 2016. Analysis utilized Kruskal–Wallis test for FSFI scores, Chi square, or Fisher’s exact test for categorical data, and regression analysis for associations.
Of 585 respondents, 278 (47.5%) had complete FSFI scores. Of these, 24 (8.6%) were premenopausal and 80 (28.8%) were pre/perimenopausal at survey completion. Median FSFI scores for premenopausal (31.2, interquartile range [IQR] 26.8–33.6) and pre/perimenopausal (29.2, IQR 25.9–32.2) were similar, whereas postmenopausal women (25.9, IQR 21.0–30.3) were significantly lower (p = 0.0007 and p = 0.0002, respectively). Premenopausal women were less likely to meet criteria for sexual dysfunction (FSFI score ≤ 26.55) than postmenopausal women (21 versus 55%, p < 0.0001, univariate analysis [odds ratio (OR) 0.32, 95% confidence interval (CI) 0.18–0.56]). Adjusting for treatment modality did not impact the significance (OR 0.43, 95% [CI] 0.23–0.80) but revealed that AIs independently are associated with sexual dysfunction (OR 2.41, 95% CI 1.32–4.40). The interaction between menopausal status and AIs was not significant (p = 0.24).
Our study demonstrates that menopausal status is associated with sexual dysfunction in breast cancer patients and sexual dysfunction in premenopausal women is not impacted by treatment modality outside of aromatase inhibitor therapy. As more premenopausal patients are treated with ovarian suppression, these data may guide clinicians in counseling patients regarding sexual dysfunction expectations.
The authors have indicated they have no potential conflicts of interest to disclose.
- 1.National Cancer Institute. National Cancer Institute: Surveillance Epidemiology and End Results Program.Google Scholar
- 4.Arraras JI, Illarramendi JJ, la Cruz de S, et al. Erratum: Quality of life in long-term premenopausal early-stage breast cancer survivors from Spain. Effects of surgery and time since surgery. J BUON. 2016;21(6):1573.Google Scholar
- 9.Regan MM, Francis PA, Pagani O, et al. Absolute benefit of adjuvant endocrine therapies for premenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2-negative early breast cancer: TEXT and SOFT Trials. J Clin Oncol. 2016;34(19):2221-31. https://doi.org/10.1200/jco.2015.64.3171.CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Koga C, Akiyoshi S, Ishida M, Nakamura Y, Ohno S, Tokunaga E. Chemotherapy-induced amenorrhea and the resumption of menstruation in premenopausal women with hormone receptor-positive early breast cancer. Breast Cancer. 2017;24(5):714-9. https://doi.org/10.1007/s12282-017-0764-1.CrossRefPubMedGoogle Scholar
- 19.Dohou J, Mouret-Reynier M-A, Kwiatkowski F, et al. A retrospective study on the onset of menopause after chemotherapy: analysis of data extracted from the Jean Perrin Comprehensive Cancer Center database concerning 345 young breast cancer patients diagnosed between 1994 and 2012. Oncology. 2017;92(5):255-63. https://doi.org/10.1159/000455049.CrossRefPubMedGoogle Scholar
- 20.Yoo C, Yun MR, Ahn J-H, et al. Chemotherapy-induced amenorrhea, menopause-specific quality of life, and endocrine profiles in premenopausal women with breast cancer who received adjuvant anthracycline-based chemotherapy: a prospective cohort study. Cancer Chemother Pharmacol. 2013;72(3):565-75. https://doi.org/10.1007/s00280-013-2227-5.CrossRefPubMedGoogle Scholar
- 22.Ribi K, Luo W, Bernhard J, et al. Adjuvant tamoxifen plus ovarian function suppression versus tamoxifen alone in premenopausal women with early breast cancer: patient-reported outcomes in the suppression of Ovarian Function Trial. J Clin Oncol. 2016;34(14):1601-10. https://doi.org/10.1200/jco.2015.64.8675.CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Saha P, Regan MM, Pagani O, et al. Treatment efficacy, adherence, and quality of life among women younger than 35 years in the International Breast Cancer Study Group TEXT and SOFT Adjuvant Endocrine Therapy Trials. J Clin Oncol. 2017;35(27):3113-22. https://doi.org/10.1200/jco.2016.72.0946.CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Ganz PA, Cecchini RS, Julian TB, et al. Patient-reported outcomes with anastrozole versus tamoxifen for postmenopausal patients with ductal carcinoma in situ treated with lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet. 2016;387(10021):857-65. https://doi.org/10.1016/s0140-6736(15)01169-1.CrossRefPubMedGoogle Scholar
- 26.Land SR, Wickerham DL, Costantino JP, et al. Patient-reported symptoms and quality of life during treatment with tamoxifen or raloxifene for breast cancer prevention: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA. 2006;295(23):2742-51. https://doi.org/10.1001/jama.295.23.joc60075.CrossRefPubMedGoogle Scholar