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The Influence of Endocrine Effects of Adjuvant Therapy on Quality of Life Outcomes in Younger Breast Cancer Survivors(二)

作者:来来来 整理:本网站论文网 录入时间:2011-12-13 23:15:34
ger women with breast cancer are more vulnerable to physical and psychological distress [5], and this greater vulnerability may account for the poorer quality of life outcomes that have been reported [6, 7]. There is variability in defining "young" in the breast cancer literature. In women’s health, young is a generally accepted description for women <35 years of age, with midlife beginning at age 35 [8]. This definition of young (<35 years of age) is consistent with published work in breast cancer that has addressed outcomes in younger versus older women [9, 10]. In this paper, young refers to women <35 years of age and young midlife women refers to those 3550 years of age.

  This paper reviews the incidence of gonadal toxicity associated with adjuvant chemotherapy, side effects of endocrine therapy, quality of life outcomes in young and young midlife breast cancer survivors, fertility concerns, and options to preserve fertility.

  OVARIAN FUNCTION AND CHEMOTHERAPY TOXICITY

  

  Ovarian toxicity is a predictable side effect of alkylating agentbased chemotherapy and is influenced by the cumulative dose and duration of therapy [11]. Chemotherapy causes destruction of primordial follicles and impairment of follicular maturation [12]. The exact mechanism of ovarian damage is not fully understood, but in vitro studies suggest apoptotic changes in the pregranulosa cells that result in follicular damage [13]. The outcomes of ovarian damage from chemotherapy are dependent on the follicular reserve of the individual woman, whichis age-related. Potential outcomes include follicular damage with preservation of menses, temporary amenorrhea, irregular menses (perimenopause), and ovarian failure (menopause).

  Younger women who preserve their menses or who develop reversible amenorrhea will experience premature menopause but as a delayed effect rather than the immediate effect observed in older midlife women [13, 14]. For the average woman, the perimenopausal transition begins 35 years of age, and over the following 1015 years, there is a gradual decline in mature functional follicles and decreasing sensitivity to gonadotropin stimulation. These changes are characterized by alterations in bleeding patterns and cycle length, anovulatory cycles, and wide variations in hormonal levels [8, 15]. These transition changes explain the age pattern of amenorrhea and ovarian failure reported in women treated with chemotherapy for breast cancer. The risk for ovarian failure is substantially higher in women who are closer to the average age of natural menopause (51 years in white nonsmoking women) because of diminished follicular reserve.

  The outcomes of women with chemotherapy-induced ovarian damage include menstrual changes, menopausal symptoms, changes in fertility potential, and infertility.

  A considerable body of research has been published identifying the incidence, and variables of age, dose, and drug(s) associ

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