Urinary symptoms in breast cancer: a systematic review

A large body of research has documented the prevalence and severity of menopausal symptoms, especially vasomotor symptoms, in breast cancer survivors and their impact on quality of life. However, urinary symptoms as part of the constellation of menopausal symptoms have received relatively little attention. Thus, less is known about the prevalence and severity of urinary symptoms in breast cancer survivors. The authors of this report conducted a systematic review of studies published between 1990 and 2010 to describe the prevalence and severity of urinary symptoms in breast cancer survivors. In total, 16 eligible studies that involved >2500 women were identified. The studies varied with respect to purpose, design, and nature of the samples included; the majority used the same definition and assessment approach for urinary symptoms. Prevalence rates for symptoms ranged from 12% of women reporting burning or pain on micturition to 58% reporting difficulty with bladder control. Although, in many studies, the largest percentage of women rated symptoms as mild, 23% reported severe symptoms. Symptoms appeared to adversely affect women's quality of life. The authors concluded that there is a need for additional research assessing the natural history of urinary symptoms using consensus definitions and validated measures in diverse populations. Nevertheless, this review suggested that clinicians should screen for urinary symptoms in breast cancer survivors and should offer treatment recommendations or make referrals as appropriate.     

绝经状态影响饮茶与乳腺癌患病风险关系的meta分析

目的：探讨绝经状态是否影响饮茶与乳腺癌患病风险之间的潜在关系。方法：以茶、茶多酚和乳腺癌为主题词联合检索Web of Science、PubMed、Medline、中国知网、维普、万方数据库1996年1月1日至2017年8月31日发表的相关文献。使用Stata 11.0软件进行效应值的合并和异质性检验,用NOS（New Castle Ottawa Scale）量表对每篇研究进行评分,通过Begg秩相关检验,Egger线性回归及剪补法计算发表偏倚。结果：本次研究共纳入9篇文献,通过比较茶饮品最高摄入量组和最低摄入量组乳腺癌的患病风险,结果初步表明饮茶对乳腺癌患病风险的影响无统计学意义（OR=1.01,95% CI：0.86~1.18）,且绝经前（OR=0.92,95% CI：0.82~1.04）和绝经后（OR=1.11,95% CI：0.93~1.33）饮茶与乳腺癌患病的关联也无统计学意义（P < 0.05）。另外,在亚组分析中也未发现绝经状态会影响饮茶人群的乳腺癌患病风险。结论：饮茶与乳腺癌患病风险无关,且绝经状态不会影响饮茶人群的乳腺癌患病风险。但目前研究证据还比较有限。故在今后的研究中需开展大样本、多中心的队列或病例对照研究来进一步验证这一结论的准确性。     

Oral progestagens before menopause and breast cancer risk

We examined the relationship between use of progestagen-only before menopause (except for mini-pills) after the age of 40 and invasive breast cancer risk in 73 664 women from the French E3N cohort study (mean age at start of follow-up, 51.8 years; mean duration of follow-up, 9.1 years). A total of 2390 cases of invasive breast cancer were diagnosed during follow-up. Risk estimates were calculated using the Cox proportional hazard model. Overall, ever use of progestagen before menopause was not significantly associated with risk (relative risk (RR): 1.01, 95% confidence interval: 0.93-1.11). However, we observed a significant increase in risk associated with the duration of use (P-value for trend: 0.012), current use of progestagens for longer than 4.5 years being significantly associated with risk (RR: 1.44, 95% confidence interval: 1.03-2.00). Prolonged use of progestagens after the age of 40 may be associated with an increased risk of breast cancer and the subject needs to be investigated further.     

乳腺癌患者的心理问题探讨

乳腺癌患者在诊疗过程中会产生各种心理问题。负性情绪严重影响着患者的心理健康和生活质量;正性情绪对病人大有裨益,有助于癌症患者建立对疾病治愈的希望和信心,提高患者的远期生存率。在治疗过程中,医务工作者应尽可能的减少患者负性情绪的产生,并通过一定的手段对患者进行心理干预,放大正性情绪,从而对治疗产生积极的影响。     

Prevention of chemotherapy-induced menopause by temporary ovarian suppression with goserelin in young, early breast cancer patients.

BACKGROUND: Standard methods to prevent chemotherapy-induced early menopause in young, breast cancer patients are unavailable to date. Preclinical data has suggested that luteinising hormone-releasing hormone (LH-RH) analogs given during treatment can decrease the gonado-toxicity induced by chemotherapy. This phase II study aimed to assess the activity of such a method in young, breast cancer patients undergoing adjuvant chemotherapy. PATIENTS AND METHODS: Premenopausal patients received the LH-RH analog goserelin 3.6 mg every 4 weeks before and during chemotherapy. According to two-stage optimal phase II Simon design, treatment was considered clinically interesting if it was able to prevent menopause in 19 out of 29 patients of the study population. The resumption of ovarian function was defined by a resumption of menstrual activity or by a follicle-stimulating hormone (FSH) value < or = 40 IU/l within 12 months after the last cycle of chemotherapy. RESULTS: Thirty patients were enrolled and 29 were evaluable. Median age was 38 years (range 29-47). All but one patient received CEF regimen (cyclophosphamide, epirubicin, 5-fluorouracil). Resumption of menstrual activity was observed in 21 patients (72%; 95% CI 52% to 87%) and a FSH value < or = 40 IU/l in 24 patients (83%; 95% CI 63% to 93%). Menses resumption was observed in 16 out of 17 patients (94%) with age <40 years and in five out of 12 patients (42%) with age > or = 40 years. CONCLUSION: Goserelin given before and during chemotherapy may prevent premature menopause in the majority of patients. The different success rate by age, however, indicates the need of a prospective evidence of the efficacy of such a strategy.     

Gynecological characteristics related to breast cancer in pre and postmenopausal women

Background The objective of this study was two fold: to identify gynecological characteristics that distinguish women diagnosed with early-stage breast cancer from those at more advanced stages; to identify distinguishing characteristics between premenopasual and postmenopausal women diagnosed with the same stage. Population and method 186 incident cases diagnosed with breast cancer were identified out of the 685 patients who were seen to in 2000–2001. The variables to be studied were obtained by means of a specific questionnaire which collected data concerning reproductive characteristics and contraceptive types. Results Significant differences in the mean age were found, since the early-stage group was younger (57.01±12.82 vs. 65.06±15.11). Characteristical factors found in pre-menopausal women were: early menopause, they either had no children or a single child, no breastfeeding practice and a more extensive use of contraceptives. Postmenopausal women presented more advanced stages, more pregnancies and less abortions. Conclusions By taking the obtained results into consideration, it would be recommendable to bring forward the age at which women are to be included in early detection programmes, and to conduct a follow-up of those women who present such factors to favour an earlier diagnosis of the disease.     

The impact of bilateral breast cancer on the prognosis of breast cancer: a comparative study with unilateral breast cancer

BACKGROUND: The clinical significance of bilateral breast cancer is unclear and its influence on prognosis is controversial. We assessed the impact of synchronous and metachronous bilateral breast cancer on the prognosis compared with unilateral breast cancer. METHODS: Between January 1, 1960 and December 31, 2001, 1,214 women were treated for primary operable breast cancers. Thirteen (1.1%) had synchronous bilateral breast cancer; 33 (2.7%) had a metachronous contralateral breast cancer. We compared age at operation, menopausal status, clinical stage, tumor size and histology, lymph node status, hormone receptor status, and use of adjuvant chemotherapy or hormone therapy, and we analyzed the impact of these factors on recurrence and survival in the 46 patients with bilateral breast cancer and the 1,168 patients with unilateral breast cancer. RESULTS: The 5-and 10-year disease-free survival rates, respectively, were 65% and 65% in metachronous cases, 85.7% and 64.3% in synchronous cases, and 77.9% and 72.1% in unilateral cases. There was no significant difference in overall survival among the three groups. On multivariate analysis, metachronous bilaterality, tumor size, lymph node status and adjuvant hormone therapy were each independent risk factors for recurrence, whereas bilaterality of breast cancer did not influence overall survival. CONCLUSIONS: Our data suggest that metachronous bilateral breast cancer is associated with shorter disease-free survival than synchronous bilateral or unilateral breast cancer, although overall survival does not differ among the 3 groups. Patients with metachronous bilateral breast cancer should be followed particularly closely in order to detect recurrence early and maximize quality of life.     

Risk factors for breast cancer by age and menopausal status: a case-control study in Singapore

A case-control study was conducted among Singapore Chinese women, comprised of 200 histologically confirmed cases of breast cancer and 420 hospital controls. Subjects were interviewed on family history of breast cancer, social and demographic characteristics, reproductive history, and diet one year prior to interview. Differences in risk factors were observed according to menopausal status. In the premenopausal group, the most consistently significant nondietary effect was an increased risk with late age at first birth. In postmenopausal women, the most consistent nondietary effects were increased risks with nulliparity, tall stature, high educational status, and a family history of breast cancer. In premenopausal women, the strongest dietary effects were low risks with high intakes of polyunsaturated fatty acids (PUFA), -carotene, soya protein as a proportion of all protein, and a high risk with high red-meat intake. No dietary effects were observed in postmenopausal women. Examination of effects by 10-year age groups suggested that the differences in the effects of age at first birth, nulliparity, height, education, -carotene intake, and PUFA intake between premenopausal and postmenopausal women were at least partly attributable to age-related differences in the baseline distributions of these variables. The variation in the effects of red meat and soya protein appeared to be attributable mainly to menopausal status itself, which is consistent with the hypothesis that these factors operate on risk by way of hormonal mechanisms.Drs HP Lee and J Lee are with the Department of Community, Occupational and Family Medicine, National University of Singapore. Ms Gourley is with Gleneagles Hospital, Singapore. Dr Estève is with the International Agency for Research on Cancer, Lyon, France. Mr Duffy and Dr Day are with the Medical Research Council Biostatistics Unit, Cambridge, UK. Address correspondence to Dr HP Lee, Professor and Head, Department of COFM, National University of Singapore, Lower Kent Ridge Road, Singapore 0511. Funding for this study was provided by the International Agency for Research on Cancer.     

Association between the apolipoprotein E genotypes and breast cancer patients in Taiwanese

Summary To display the association between the apolipoprotein E (APOE) genotypes and breast cancer patients, a cross sectional study including 291 patients and 148 controls was performed. The APOE genotypes were measured in all participants, and the pathological diagnosis, estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (HER-2) among breast cancer patients were collected. The results showed the APOE allele frequency in breast cancer patients was 11.7% ɛ2 carriers, 74.6% ɛ3 carriers and 13.7% ɛ4 carriers, and there was no significant difference when they were compared with those of the control group (15.5% ɛ2 carriers, 74.3% ɛ3 carriers and 10.1% ɛ4 carriers; p=0.342). Among the patients in pre-menopause, showed a higher frequency of ɛ2 carriers had the cancer site on the left than that of the ɛ3 carriers (78.6% versus 40.3%; p=0.019). Among breast cancer patients, there was no significant association between the APOE genotypes and menopausal status, pathological diagnosis, estrogen receptor, progesterone receptor, and HER-2. Our findings demonstrated that the APOE genotypes were not associated with breast cancer patients, and ɛ2 allele tended to induce breast cancer on the left site among those patients in pre-menopause.Shun-Jen Chang and Ming-Fong Hou contributed equally to this work.     

Adherence to adjuvant therapy in post-menopausal breast cancer patients: a review

This review aimed to address the concept of adherence to adjuvant therapy in post-menopausal women. Thirteen studies were included in the review. Study quality was assessed using Critical Appraisal Skills Programme and CONSORT tools. Adherence to adjuvant medication was assessed using a variety of methods. Estimates of adherence rates to adjuvant therapies indicated that of the post-menopausal women prescribed adjuvant therapy, between 15% and 55% were adherent to tamoxifen from 1 to 5 years of follow-up, albeit two studies proposed adherence rates greater than 85%; these data may be flawed due to the methods of data collection. Between 31% and 73% of women were adherent to anastrozole, letrozole or exemestane from 1 year of treatment. These estimates of adherence are based on a variety of reported records including self-report. Current evidence on the assessment of adherence to adjuvant therapies in post-menopausal women indicate that the adherence rates of medication maybe suboptimal and therefore therapeutic efficacy is questionable and may increase the risk of cancer recurrence and reduce disease survival rates. Concerted research is needed to investigate adherence rates, examine patient health beliefs in the medication management of post-menopausal breast cancer patients and also develop new measures to assess adherence with medication.     

Urinary androgens and breast cancer risk: results from a long-term prospective study based in Guernsey

Between 1961 and 1967 a cohort of over 5000 women volunteered for a prospective study to determine the relationship between the urinary androgen metabolites, androsterone (A) and aetiocholanolone (E), and risk of breast cancer. During the first 10 years of the study the concentration of urinary A and E was determined in 1887 of the urine specimens. In 1971 we reported that subnormal amounts of urinary A and E were associated with a significantly increased risk of breast cancer. The cohort has been followed regularly during the 37 years since inception of the study and, by May 1998, 248 women had been diagnosed with breast cancer. Urinary androgen metabolites had been measured in 116 of these cases. Analysis of these data confirmed that women diagnosed in the first decade of the study were more likely to have low levels of urinary androgen metabolites. In the following decades, however, those who developed breast cancer were more likely to have manifested an increased A and E excretion. The reversal in the relationship between androgen metabolite excretion and risk suggests that age, or probably more importantly, menopausal status at diagnosis is an important modifying factor. Dichotomizing at age 50 it was found that in the younger age group (predominantly premenopausal) the rate ratios in the lowest tertile of A or E excretion were two- to threefold greater than for those in the highest tertile (chi2(1) = 3.57; P = 0.06: chi2(1) = 4.70; P = 0.03 for A and E respectively). In contrast, in the older age group comprising predominantly post-menopausal women, the rate ratios associated with the lowest tertile of A or E were half that of those in the highest tertile (chi2(1) = 4.10; P = 0.04; chi2(1) = 8.72; P = 0.003 for A and E respectively). This suggests that there may be different endocrine promotional factors for pre-and post-menopausal breast cancer. Hormonal risk factors may vary during the lifetime of an individual woman and this may have profound consequences for prevention strategies.     

Menopause and colorectal cancer

Post-menopausal women who have never used hormone replacement therapy have a higher risk of colon, but not rectal, cancer than do premenopausal women of the same age, socio-cultural class and dietary habits. Such risk increase seems to last about 10 years and to be restricted to lean women, a group who have lower levels of oestradiol after ovarian function ceases after menopause.     

Partial breast irradiation versus whole breast radiotherapy for early-stage breast cancer: a decision analysis

PURPOSE: To compare the quality-adjusted life expectancy between women treated with partial breast irradiation (PBI) vs. whole breast radiotherapy (WBRT) for estrogen receptor-positive early-stage breast cancer. METHODS AND MATERIALS: We developed a Markov model to describe health states in the 15 years after radiotherapy for estrogen receptor-positive early-stage breast cancer. Breast cancer recurrences were separated into local recurrences and elsewhere failures. Ipsilateral breast tumor recurrence (IBTR) risk was extracted from the Oxford overview, and rates and utilities were adapted from the literature. We studied two cohorts of women (aged 40 and 55 years), both of whom received adjuvant tamoxifen. RESULTS: Assuming a no evidence of disease (NED)-PBI utility of 0.93, quality-adjusted life expectancy after PBI (and WBRT) was 12.61 (12.57) and 12.10 (12.06) years for 40-year-old and 55-year-old women, respectively. The NED-PBI utility thresholds for preferring PBI over WBRT were 0.923 and 0.921 for 40-year-old and 55-year-old women, respectively, both slightly greater than the NED-WBRT utility. Outcomes were sensitive to the utility of NED-PBI, the PBI hazard ratio for local recurrence, the baseline IBTR risk, and the percentage of IBTRs that were local. Overall the degree of superiority of PBI over WBRT was greater for 55-year-old women than for 40-year-old women. CONCLUSIONS: For most utility values of the NED-PBI health state, PBI was the preferred treatment modality. This result was highly sensitive to patient preferences and was also dependent on patient age, PBI efficacy, IBTR risk, and the fraction of IBTRs that were local.     

乳腺癌患者营养状况分析

目的:回顾性分析84例乳腺癌患者治疗过程的营养状况,为乳腺癌患者进行营养支持提供指导。方法:运用回顾性调查的方法,对乳腺癌患者手术前后、每疗程化疗前后的人体测量指标、生化指标、血液学指标进行分析。结果:手术前后及化疗前后患者TP、ALB、HB、TLC及BMI均有显著性差异(P<0.05)。结论:手术、化疗均会造成乳腺癌患者的营养状况下降,但不同治疗时期表现营养状况下降的指标各有侧重。     

Evaluation of a group cognitive behavioural intervention for women suffering from menopausal symptoms following breast cancer treatment

Objective: To evaluate a group cognitive behavioural intervention to alleviate menopausal symptoms in women who have had treatment for breast cancer. Methods: A single group design was used with pre‐ and post‐treatment assessment and a 3‐months follow‐up. Seventeen women who had completed active breast cancer treatment were treated. Following a 2‐week daily diary assessment they were offered 6 (90 min) weekly sessions of Group cognitive behaviour therapy (CBT). The CBT included information and discussion, relaxation and paced breathing and CBT to reduce stress and manage hot flushes (HF), night sweats (NS) and sleep. The primary outcome measure was Hot Flush Frequency and Hot Flush Problem Rating; secondary outcomes included the Women's Health Questionnaire (WHQ) and health‐related quality of life (SF 36). Beliefs about HF were monitored in order to examine the effects of cognitive therapy. Results: HF and NS reduced significantly following treatment (38% reduction in frequency and 49% in problem rating) and improvements were maintained at 3 months follow‐up (49% reduction in frequency and 59% in problem rating). Depressed mood, anxiety and sleep (WHQ) significantly improved, as did aspects of quality of life (SF 36) (emotional role limitation, energy/vitality and mental health). There was a significant reduction in negative beliefs about HF, NS and sleep following CBT. Conclusions: These results suggest that CBT delivered in groups might offer a viable option for women with troublesome menopausal symptoms following breast cancer treatment, but further controlled trials are needed. Copyright © 2008 John Wiley & Sons, Ltd.     

Menopausal hot flushes after breast cancer

The study aimed to improve understanding of the natural history and impact of hot flushes after breast cancer. Data were collected from women participating in an RCT of relaxation to reduce the incidence of flushes from breast cancer follow-up clinics from two hospitals in South-East England. Repondents were 150 women experiencing hot flushes following completion of primary treatment for breast cancer. This study utilized a flush diary, the Hot Flushes and Night Sweats Questionnaire (HFNSQ), Functional Assessment of Cancer Therapy with Endocrine Subscale (FACT-ES) and Spielberger State/Trait Anxiety Index (STAI) as the main outcome measures. The study found that in this sample, 51 (34%) women experienced flushes more than five years after diagnosis and 75 (50%) more than 5 years after menopause. Sleep disruption occurred in 90 women (72% of those that returned diaries), affecting half of the nights they recorded. The mean problem rating on the HFNSQ was 4.85 out of 10. A peak incidence of flushes was apparent around 10 a.m. in women taking tamoxifen. It was concluded that hot flushes after breast cancer may be long-lasting and cause sleeping difficulties for many women. Tamoxifen may affect the diurnal pattern of flushes. After breast cancer, the duration of flushes, potential distress and disruption to women's lives should not be underestimated and appropriate interventions should be offered.     

Tubal ligation in relation to menopausal symptoms and breast cancer risk

Background:

Local inflammation after tubal ligation may affect ovarian function and breast cancer risk.

Methods:

We analysed tubal ligation, menopausal characteristics, and breast cancer risk in the Sister Study cohort (N=50 884 women).

Results:

Tubal ligation was associated with hot flashes (hazard ratio (HR) 1.09; 95% confidence interval (CI): 1.06–1.12) but not menopausal age (HR 0.99; 95% CI: 0.96–1.02). Tubal ligation did not have an impact on breast cancer overall (HR 0.95; 95% CI: 0.85–1.06), but had a suggested inverse relation with oestrogen receptor+/progesterone receptor+ invasive tumours (HR 0.84; 95% CI: 0.70–1.01), possibly because of subsequent hysterectomy/bilateral oophorectomy.

Conclusion:

Tubal ligation does not influence overall breast cancer risk.     

Estrogen-progestin replacement therapy and breast cancer risk: the Women's Health Study (United States)

Objective: While there is substantial evidence that unopposed estrogen use increases the risk of breast cancer, there are limited data from epidemiologic studies on the impact of estrogen–progestin combinations. We therefore examined estrogen–progestin replacement therapy and breast cancer risk in the Women's Health Study. Methods: We investigated postmenopausal hormone (PMH) use among 17,835 apparently healthy postmenopausal women aged 45 years, and followed them prospectively for an average of 5.9 years. Breast cancer occurred in 411 women. Results: The multivariate relative risks of all breast cancer associated with never use of PMH, use of estrogen replacement therapy (ERT), and use of estrogen–progestin replacement therapy (HRT) were 1.00 (referent), 0.96 (95% CI 0.65–1.42), and 1.37 (95% CI 1.05–1.78). The increase in risk among users of HRT was largely limited to those women who had used estrogen–progestin replacement therapy for five years or more, and to those women who were on continuous rather than cyclic progestin combinations. Higher doses of estrogen, but not progestin, were associated with increased breast cancer risk, compared with lower doses. Conclusions: These prospective data suggest that use of estrogen–progestin replacement therapy imparts an increased risk of breast cancer in comparison with never use of PMH.     

Association between Early Menopause,Gynecological Cancer,and Tobacco Smoking: A Cross-Sectional Study

Background: The rates of smoking among women are rising. Previous studies have shown that smoking is associated with early menopause. However, the association of gynecological cancer, including breast and cervical cancer, with early menopause and smoking, remains unclear. Therefore, this study aimed to determine the association between smoking and early menopause, breast cancer, and cervical cancer. Methods: This cross-sectional study used data from the Korean National Health and Nutritional Survey Examination (KHANES) (2016–2018). Early menopause was defined as menopause before 50 years of age. Results: A total of 4,481 participants were included in the analysis. There was no association between early menopause and cervical cancer (adjusted odds ratio [aOR]: 1.435, 95% confidence interval [CI]: 0.730–2.821), but women who had experienced early menopause had a significantly higher risk of breast cancer than women who had experienced normal menopause (aOR: 1.683, 95% CI: 1.089–2.602, p=0.019). Early menopause was not associated with an increased risk of breast cancer in ever-smoker (aOR: 0.475, 95% CI: 0.039–5.748), but was associated with a significantly increased risk of breast cancer in never-smokers (aOR: 1.828, 95% CI: 1.171–2.852). Conclusions: Early menopause was associated with an increased risk of breast cancer in women who had never smoked, but not in women who had ever smoked.     

Chemotherapy and pattern of metastases in breast cancer patients

A retrospective analysis of all breast cancer patients who died of their disease at Harper Grace Hospital during 1962 to 1976, was conducted to determine the pattern of metastases and its relation to chemotherapy. The autopsy incidence of distant metastases, to all organ sites, was noted to be higher among patients who previously received cytotoxic therapy, compared with those who did not. Such incidence was unrelated to differences in patients' age, menopausal status, and disease-free interval. It is postulated that chemotherapy contributes to the wider metastases, especially to the central nervous system and meninges, in a breast cancer patient. This is possibly due to a longer survival of patients treated.