breast cancer Publications מאמרים בתחום סרטן-השד
Women's post-chemotherapy parity is affected by offspring number and marital status.
Childbearing rates post-chemotherapy for breast cancer (BC) are affected by age and chemotherapy-type but may also depend on personal characteristics. In this single institution retrospective study we evaluated post-chemotherapy fertility and its association with offspring number and marital-status at the time of BC diagnosis. We identified 65 fertile BC patients under 38y, who received adjuvant-chemotherapy. Menses resumption and pregnancies along with offspring-number and marital-status were recorded. Menses resumed in 95.4% and 33.8% gave birth. Of those who did not give birth 46.5% had at least three children at diagnosis and of those without children 83% were unmarried. Our data associates multiparity with lower childbearing post-chemotherapy, suggesting it as a possible surrogate for women's preferences in retrospective studies. Unlike multiparity, marital status association with lower childbearing may be culture-dependent and not a universal surrogate for women's intentions and would be best investigated prospectively.
Copyright © 2012 Elsevier Ltd. All rights reserved.
Harefuah. 2012 .
Update: adjuvant trastuzumab in HER2 positive breast cancer
Some of the women who undergo surgery for the removal of breast cancer will need adjuvant treatment with chemotherapy, hormonal therapy, biological therapy or radiation therapy. In patients whose tumor expresses HER2, the adjuvant treatment will include Trastuzumab. In a number of prospective randomized trials performed in recent years, Trastuzumab was proven to have a significant effect in reducing by half the incidence of the recurrence of the disease and reducing the risk of death by a third. It is important to provide Trastuzumab as early as possible, together with the chemotherapy, unless treatment with doxorubicin is needed and then Trastuzumab is given later. The most significant side effect of Trastuzumab is cardiac toxicity, which is manifested in most cases by an asymptomatic decrease of the left ventricular ejection fraction in 2.3-17.3% of patients, although in most cases this has no clinical significance. Symptomatic heart failure is a rare event in Trastuzumab treated patients, occurring in 0-4% of patients and it is generally reversible with Trastuzumab discontinuation. In this review we summarize the current perspective on Trastuzumab and discuss adjuvant treatments in HER2-positive early breast cancer.
Breast J. 2008 Nov
Beginning IVF treatments after age 30 increases the risk of breast cancer: results of a case-control study.
The long-term risks of in vitro fertilization (IVF) treatment remain unclear. This study was designed to determine breast cancer risk factors in women who underwent IVF, and to establish characteristics of these tumors. Records of 7,162 consecutive women who underwent IVF at a single center between 1984 and 2002 were linked with the Israel Cancer Registry to identify women who developed breast cancer. IVF-related parameters were compared between 28 breast cancer patients who had undergone IVF (IVF BC) and for whom complete IVF data were available with 140 women who underwent IVF and did not develop breast cancer (IVF non-BC). Tumor parameters were compared between 38 patients who developed breast cancer after IVF and 114 age-matched breast cancer patients who did not undergo IVF (non-IVF BC). Age over 30 at the time of first IVF treatment, even after controlling for age at first birth, was the only parameter significantly associated with increased breast cancer risk (RR = 1.24, p = 0.02, 95% CI = 1.03-1.48). There were no differences between IVF-BC and IVF non-BC patients in all other IVF-related parameters. The only statistically significant difference in tumors developing in IVF-BC patients compared with non-IVF BC patients was in grade distribution, particularly for grade II tumors. However, the significance of such a difference is unclear. Women who start IVF after the age of 30 appear to be at increased risk of developing breast cancer. The characteristics of breast tumors in women who underwent IVF are no different than in patients without previous exposure to IVF.
Cancer. 2006 Oct
Prevention of severe menorrhagia in oncology patients with treatment-induced thrombocytopenia by luteinizing hormone-releasing hormone agonist and depo-medroxyprogesterone acetate.
Menorrhagia is a serious complication in young female oncology patients who suffer from severe thrombocytopenia during myelosuppressive treatment. To the authors' knowledge, little is known regarding the incidence of this complication or the effectiveness of possible therapies for its prevention. In this retrospective clinical study, after a thorough gynecologic evaluation, young female oncology patients with regular menstrual cycles undergoing myelosuppressive treatments received either depo-medroxyprogesterone acetate (DMPA), or D-tryptophan-6-luteinizing hormone-releasing hormone depot treatment (gonadotropin-releasing hormone agonist [GnRH-a]), or no treatment before the administration of myelosuppresive chemotherapy. Only patients who later developed severe thrombocytopenia (<25,000 platelets per muL) were included in the study. Daily blood counts, menorrhagia, nonvaginal bleeding episodes, and the need for blood products, gynecologic consultations, and other medical interventions were determined. Of 101 women with cancer who met the inclusion criteria, 42 patients received DMPA, 39 patients received GnRH-a, and 20 patients remained untreated. The mean duration (+/- standard deviation) of severe thrombocytopenia was 24.76 +/- 23.6 days. Four patients were not included because of significant gynecologic pathologies. General bleeding from nongynecologic sites was similar for all groups and was not associated with vaginal bleeding. Severe or moderate menorrhagia was documented in none of the 39 women who received GnRH-a, in 9 patients (21.4%) who received DMPA, and in 9 untreated patients (40%; P = .02). Fewer calls for urgent gynecologic consultations were documented in the GnRH-a group compared with the untreated group (P < .0001). Female patients undergoing myelosupressive therapy are at high risk of developing significant menorrhagia during prolonged, severe thrombocytopenia. Pretreatment gynecologic evaluation can detect significant pelvic pathologies. GnRH-a treatment effectively prevented menorrhagia, whereas DMPA administration was less effective.
(c) 2006 American Cancer Society.
N Engl J Med. 2004 Dec
Images in clinical medicine. Lytic lesions in breast cancer.
Isr Med Assoc J. 2008 Apr