What Can We Learn From Menstrual Patterns After Treatment for HER2-Positive Breast Cancer?

Treatment-related amenorrhea is a well-recognized consequence of chemotherapy in some premenopausal women (1). Amenorrhea is an imperfect surrogate for infertility and menopausal symptoms because it usually reflects at least temporary ovarian dysfunction. It has been associated with improved prognosis in hormone receptor–positive breast cancer (2–5). In a pivotal study published in the New England Journal of Medicine in 2010, Swain and colleagues reported that women with lymph node–positive breast cancer who experienced chemotherapy-related amenorrhea for six months or more had better disease-free survival and overall survival than those who did not across a variety of chemotherapy regimens, including doxorubicin and cyclophosphamide (AC) followed by docetaxel; concurrent AC and docetaxel; or concurrent doxorubicin and docetaxel (AT) (5). A subset analysis showed that this was true only in those with estrogen receptor (ER)–positive disease, who had a hazard ratio for death of 0.52 (P = .002) if they had experienced chemotherapy-related amenorrhea (6).

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