Obesity may decrease the amenorrhea associated with chemotherapy in premenopausal breast cancer patients

We read with great interest the article by Berclaz et al. [1Go], which stated that body mass index (BMI) is an independent prognostic factor for overall survival in patients with breast cancer, especially among pre-/perimenopausal patients treated with chemotherapy without endocrine therapy. These authors proposed different explanations for this association. We would like to mention another explanation.

Amenorrhea is also an important prognostic factor for predicting the efficacy of chemotherapy in premenopausal patients [2Go]. It is known that obese women have a longer reproductive life and that longer exposure to estrogen increases breast cancer risk. Although there were insufficient data to demonstrate that chemotherapy is associated with a decreased incidence of amenorrhea in obese patients compared with lean counterparts, Mehta et al. [3Go] showed that 71% of obese patients develop amenorrhea after receiving chemotherapy, compared with 80% of non-obese breast cancer patients. In light of the above information, we propose that obesity itself, by suppressing the amenorrhea associated with chemotherapy, may result in poorer prognosis in premenopausal breast cancer patients with a high BMI.

K. Altundag1,*, O. Altundag1, P. Morandi2 and M. Gunduz3

1 Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey; 2 Department of Medical Oncology, S. Bortolo General Hospital, Vicenza, Italy 3 Department of Oral Pathology and Medicine, Graduate School of Medicine and Dentistry, Okayama University, Japan

* Email: drkadri{at}usa.net

References

1. Berclaz G, Li S, Price KN et al. Body mass index as a prognostic feature in operable breast cancer: the International Breast Cancer Study Group experience. Ann Oncol 2004; 15: 875–884.[Abstract/Free Full Text]

2. Poikonen P, Saarto T, Elomaa I et al. Prognostic effect of amenorrhea and elevated serum gonadotropin levels induced by adjuvant chemotherapy in premenopausal node-positive breast cancer patients. Eur J Cancer 2000; 36: 43–48.[CrossRef][ISI][Medline]

3. Mehta RR, Beattie CW, Das Gupta TK. Endocrine profile in breast cancer patients receiving chemotherapy. Breast Cancer Res Treat 1992; 20: 125–132.[ISI][Medline]





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