Anti‐Müllerian hormone and risk of ovarian cancer in nine cohorts

Animal and experimental data suggest that anti‐Müllerian hormone (AMH) serves as a marker of ovarian reserve and inhibits the growth of ovarian tumors. However, few epidemiologic studies have examined the association between AMH and ovarian cancer risk. We conducted a nested case‐control study of 302 ovarian cancer cases and 336 matched controls from nine cohorts. Prediagnostic blood samples of premenopausal women were assayed for AMH using a picoAMH enzyme‐linked immunosorbent assay. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariable‐adjusted conditional logistic regression. AMH concentration was not associated with overall ovarian cancer risk. The multivariable‐adjusted OR (95% CI), comparing the highest to the lowest quartile of AMH, was 0.99 (0.59–1.67) (P_trend: 0.91). The association did not differ by age at blood draw or oral contraceptive use (all P_{heterogeneity}: ≥0.26). There also was no evidence for heterogeneity of risk for tumors defined by histologic developmental pathway, stage, and grade, and by age at diagnosis and time between blood draw and diagnosis (all P_{heterogeneity}: ≥0.39). In conclusion, this analysis of mostly late premenopausal women from nine cohorts does not support the hypothesized inverse association between prediagnostic circulating levels of AMH and risk of ovarian cancer.     

Circulating anti‐Müllerian hormone and breast cancer risk: A study in ten prospective cohorts

A strong positive association has been observed between circulating anti‐Müllerian hormone (AMH), a biomarker of ovarian reserve, and breast cancer risk in three prospective studies. Confirming this association is important because of the paucity of biomarkers of breast cancer risk in premenopausal women. We conducted a consortium study including ten prospective cohorts that had collected blood from premenopausal women. A nested case–control design was implemented within each cohort. A total of 2,835 invasive (80%) and in situ (20%) breast cancer cases were individually matched to controls (n = 3,122) on age at blood donation. AMH was measured using a high sensitivity enzyme‐linked immunoabsorbent assay. Conditional logistic regression was applied to the aggregated dataset. There was a statistically significant trend of increasing breast cancer risk with increasing AMH concentration (p_trend across quartiles <0.0001) after adjusting for breast cancer risk factors. The odds ratio (OR) for breast cancer in the top vs. bottom quartile of AMH was 1.60 (95% CI = 1.31–1.94). Though the test for interaction was not statistically significant (p_interaction = 0.15), the trend was statistically significant only for tumors positive for both estrogen receptor (ER) and progesterone receptor (PR): ER+/PR+: OR_Q4–Q1 = 1.96, 95% CI = 1.46–2.64, p_trend <0.0001; ER+/PR?: OR_Q4–Q1 = 0.82, 95% CI = 0.40–1.68, p_trend = 0.51; ER?/PR+: OR_Q4–Q1 = 3.23, 95% CI = 0.48–21.9, p_trend = 0.26; ER?/PR?: OR_Q4–Q1 = 1.15, 95% CI = 0.63–2.09, p_trend = 0.60. The association was observed for both pre‐ (OR_Q4–Q1= 1.35, 95% CI = 1.05–1.73) and post‐menopausal (OR_Q4–Q1 = 1.61, 95% CI = 1.03–2.53) breast cancer (p_interaction = 0.34). In this large consortium study, we confirmed that AMH is associated with breast cancer risk, with a 60% increase in risk for women in the top vs. bottom quartile of AMH.     

Antimullerian hormone and inhibin B are hormone measures of ovarian function in late reproductive‐aged breast cancer survivors

BACKGROUND:

In late reproductive‐aged breast cancer survivors, there is a need for real‐time biomarkers of postchemotherapy ovarian function. The objective was to determine whether antimullerian hormone (AMH) and inhibin B are such biomarkers. The authors tested whether AMH and inhibin B were impacted by breast cancer treatment by comparing cancer survivors to age‐matched control women and determined the association between these hormones and postchemotherapy menstrual pattern.

METHODS:

Breast cancer patients (n = 127) with American Joint Committee on Cancer stage I to III disease who were premenopausal at diagnosis were enrolled postchemotherapy and observed. The primary endpoint was chemotherapy‐related amenorrhea (CRA) (≥12 months of amenorrhea after chemotherapy). Matched pair analyses compared AMH, inhibin B, and follicle‐stimulating hormone (FSH) levels between cancer and age‐matched control subjects. Associations between hormones, CRA status, and change in CRA status over time were assessed.

RESULTS:

The median age of the patients at chemotherapy was 43.2 years (range, 26.7‐57.8 years). At enrollment, median follow‐up since chemotherapy was 2.1 years, and 55% of subjects had CRA. Compared with age‐matched controls, cancer subjects had significantly lower AMH (P = .004) and inhibin B (P < .001) and higher FSH (P < .001). AMH (P = .002) and inhibin B (P = .001) were found to be significantly associated with risk of CRA, even after controlling for FSH. AMH was significantly lower (P = .03) and FSH was significantly higher (P = .04) in menstruating subjects who developed subsequent CRA.

CONCLUSIONS:

AMH and inhibin B are 2 additional measures of postchemotherapy ovarian function in late reproductive‐aged breast cancer survivors. With further research and validation, these hormones may supplement limited current tools for assessing and predicting postchemotherapy ovarian function. Cancer 2010. © 2009 American Cancer Society.     

The influence of different intensity of treatment on hormonal markers of gonadal function in acute lymphoblastic leukemia survivors

Anti‐cancer treatment in children can deteriorate gonadal function and affect future fertility. We analyzed the hormonal markers of gonadal function in adolescent leukemia survivors, treated in childhood with different levels of aggressiveness. We analyzed hormone levels in 69 adolescents and young adults, leukemia survivors stratified into standard (SR), intermediate (IR), and high (HR) risk groups, and in 80 healthy controls (38 men) at a similar age. We assessed follicular stimulating hormone (FSH), luteinizing hormone (LH), and inhibin B in the whole group, testosterone in males, and E2 and anti‐Müllerian hormone (AMH) in females. Males classified into HR group presented, in comparison to control, higher levels of FSH, LH, lower inhibin B, and normal testosterone, whereas in SR and IR group, the hormonal values were comparable to the control. In females, in all risk groups, the levels of FSH, LH, E2, and inhibin B were comparable with the control, but the mean AMH levels were slightly lowered. We did not observe the effect of prophylactic cranial irradiation (12 or 18 Gy) or the time of treatment (before vs. during puberty) on hormone levels. In females, a positive correlation was found between the time interval after the end of treatment and AMH levels. Male leukemia survivors having undergone more intensive chemotherapy show the symptoms of disturbed spermatogenesis and need to be followed‐up in the future. Women, irrespective of the risk group, can develop the signs of preterm ovarian insufficiency. They should be informed about the impact of the treatment on gonadal function.