[Show abstract][Hide abstract] ABSTRACT: Background
Each year, approximately 11% of women diagnosed with breast cancer in the United States are 45 years of age or younger. These women have concerns specific to or accentuated by their age, including fertility-related concerns, and have higher rates of psychosocial distress than women diagnosed at older ages. Current guidelines recommend that fertility risks be considered early in all treatment plans; however, the extant research indicates that attention to fertility by the healthcare team is limited. Importantly, attention to fertility may be a proxy for whether or not other important issues warranting attention in younger women with breast cancer are addressed, including genetic risks, psychosocial distress, sexual functioning, and body image concerns. The Young & Strong study tests the efficacy of an intervention designed for young women recently diagnosed with breast cancer and their oncologists with the intention to: 1) increase attention to fertility as an important surrogate for other issues facing young women, 2) educate and support young women and their providers, and 3) reduce psychosocial distress among young women with breast cancer.Methods/DesignThe study employs a cluster randomized design including 14 academic institutions and 40 community sites across the U.S. assigned to either the study intervention arm or contact-time comparison intervention arm. Academic institutions enroll up to 15 patients per site while community sites enroll up to 10 patients. Patient eligibility requirements include: an initial diagnosis of stage I-III invasive breast cancer within three months prior, without a known recurrence or metastatic breast cancer; 18¿45 years of age at diagnosis; ability to read and write in English. The primary outcome is oncologists¿ attention to fertility concerns as determined by medical record review. Secondary outcomes include differences in patient satisfaction with care and psychosocial distress between the two study arms.DiscussionStudy findings will provide valuable insight into how to increase attention to fertility and other issues specific to young women with breast cancer and how to improve doctor-patient communication around these issues, which may promote better quality of care for this population.Trial registration NCT01647607. Registered July 19, 2012.
BMC Public Health 01/2015; 15(1):37. DOI:10.1186/s12889-015-1346-9 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare markers of ovarian reserve between women exposed to cytotoxic chemotherapy for early stage breast cancer and matched controls.
Cross-sectional evaluation of markers of ovarian reserve.
Dana-Farber/Brigham and Women's Cancer Center, Massachusetts General Hospital, and Faulkner Hospital in Boston, MA.
Breast cancer survivors with continued menses after chemotherapy were compared with age-matched, gravidity-matched controls.
Antral follicle count (AFC), anti-Müllerian hormone (AMH), FSH, inhibin B (InB), and E(2) on day 2, 3, or 4 of the menstrual cycle. A Bonferroni correction was performed to correct for multiple comparisons.
Twenty survivors and 20 controls were evaluated; 50% of survivors were currently on tamoxifen. Median AFC was 6 for survivors and 9.5 for controls. There were significant differences between the two groups in AFC, AMH, and nonsignificant differences in FSH and InB, all indicating better ovarian reserve in controls. The AFC and AMH levels were highly correlated (r = 0.72). Survivors on tamoxifen had lower AFC, AMH, InB, and higher E(2) than nontamoxifen-treated survivors.
Premenopausal breast cancer survivors have diminished ovarian reserve compared with controls.
Fertility and sterility 05/2009; 94(2):638-44. DOI:10.1016/j.fertnstert.2009.03.045 · 4.59 Impact Factor