Abstract:
Background: Globally, there is an increase in breast cancer (BC) diagnoses before the age of 40 years were these individuals are in their reproductive age. One of the most significant side effects of chemotherapy for premenopausal women with BC is Chemotherapy-induced Amenorrhea (CIA). Most of the data on CIA in BC women is from high-income countries and data in Africa is lacking. This study will provide an understanding CIA among premenopausal women with BC and improve the Health-related Quality of Life (HRQOL) for premenopausal women with BC and CIA after completing treatment.
Objective: To determine the prevalence of the CIA which is defined as cessation of menses within a year after beginning chemotherapy and continuing for at least 12 months, its associated factors, and influences of CIA on HRQOL among premenopausal women with BC in Tanzania.
Methodology: A cross-sectional study was conducted from November 2024 to February 2025 among premenopausal BC women who completed chemotherapy > 1 year. Structured questionnaires were used to collect predictive variables such as age, chemotherapy regimen and tamoxifen use. HRQOL was assessed using the Short Form Survey-36 questionnaire. Data analysis was done using the computer program SPSS version 23. Categorical variables were summarized using frequencies and percentages. Continuous variables were summarized using mean and standard deviation or median and interquartile range, depending on distribution. Student t-test was used to compare means, and the Mann-Whitney U test was used to compare medians. Logistic regression was used to identify the predictors of CIA. Multiple linear regression was used in the multivariate analysis to adjust the mean scores of SF-36 by age at diagnosis, the use of Tamoxifen, and mode of payment and also used to compare the mean scores of SF-36 scales between patients with CIA versus without CIA, as well as general population. P values < 0.05 was considered statistically significant.
Result: Among 150 patients with regular menstruation before starting chemotherapy with age between 36 to 43 years, the prevalence of persistent CIA was 94.5% overall; 89.5% among those patients on Tamoxifen. Age above 40 years at diagnosis (OR: 1.3, 95% CI 1.1-1.5, P < 0.01), tamoxifen use (OR: 8.9, 95% CI 1.3- 59.6, P <0.03), and insured patients (OR: 0.1, 95%.CI 0.02-0.9, P <0.03) were statistically significant associated with CIA. Only 3.3% received GnRHa post-chemotherapy for ovarian function suppression. None were using contraceptives. No statistically differences were found on any SF-36 scales between patients with CIA versus without CIA, despite CIA been associated with low libido, vaginal dryness and insomnia. However, in comparing BC survivors with the general population in Tanzania, mean scores for social functioning (P <0.02) and physical functioning (P <0.01) were significantly better in general population whereas for general health scale (P <0.01) was better in BC patients compare to general population.
Conclusion: The prevalence of persistent CIA was 94.5% in the entire group. There was a low uptake in using GnRHa and none of the patients were on contraceptives. The CIA did not influence HRQOL although it was associated with lower the libido, increase insomnia and vaginal dryness. None of the patients were given fertility counselling before chemotherapy. Further prospective studies are needed to evaluate the incidence of the CIA and its impact on HRQOL and prognosis.
