INCIDENCE, TIME COURSE, AND DETERMINANTS OF MENSTRUAL BLEEDING AFTER BREAST CANCER TREATMENT. A PROSPECTIVE STUDY Jeanne A. Petrek, M.D., Michelle Naughton, Ph.D., Doug Case, Ph.D., Eva Singletary, M.D., Elizabeth Naftalis, M.D., and Electra Paskett, Ph.D. Memorial Sloan-Kettering Cancer Center, New York, NY; Wake Forest University, Winston-Salem, NC; University of Texas M.D. Anderson Cancer Center, Houston, TX; University of Texas Southwestern Medical Center at Dallas, Dallas, TX; Ohio State University, Columbus, OH There has been no trial yet designed to evaluate ovarian function as a primary endpoint and to compare systemic adjuvant therapies concurrently. 595 U S women ages 20 - 45 years were accrued from January 1998 to July 2002 within 8 months of diagnosis with Stages I – III breast cancer (median followup 45 months) and daily bleeding records were obtained. Baseline extensive clinical, demographic, quality of life and treatment data (with each drug, dose, and date of adjuvant chemotherapy) was obtained with followup every six months. Repeated measures logistic regression was used to assess which variables were predictive of monthly bleeding and to generate probability plots of expected monthly bleeding over time. Significantly different proportions of women had monthly bleeding depending upon their age (p<.001), chemotherapy program and time interval after that program, as shown in the accompanying graph. In the month after the standard course of doxorubicin and cyclophosphamide (AC) whether or not followed by paclitaxel (T) or docetaxel (R), approximately 16% had monthly bleeding compared to the immediate month after a standard course of cyclophosphamide, methotrexate, 5-fluorouracil (CMF), in which 48% bled (p<.001). Following the three AC programs, there was a slow recovery phase of about 9 months followed by a plateau during which almost half continued monthly bleeding for the remainder of the study follow-up compared to after CMF in which there was no recovery phase and a continual decline in bleeding to about 18% of women with monthly bleeding at study end (p<.001) compared to the AC programs. After chemotherapy there was a small effect of monthly bleeding with tamoxifen use which varied with time. Probability graphs of monthly bleeding in hypothetical patients 30, 35, 40, and 45 years of age treated with each of the four treatment regimens were generated. Using daily bleeding records, it is demonstrated that age and the specific adjuvant program impact ovarian function. This unique data set enabled us to produce probability plots from which clinicians can predict the chances of menstrual cycle maintenance in an individual patient. Original work supported by the U.S. Army Medical Research and Materiel Command under DAMD17- 96-1-6292 and current work supported by DAMD17-01-1-0447. Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.