BRCA Mutation Not Associated with Chemotherapy-Induced Amenorrhea

Data from previous studies suggest that women who are BRCA1/2 mutation–positive may have diminished rates of fertility. In one recent trial, young BRCA1/2 mutation–positive breast cancer patients who underwent oocyte cryopreservation before chemotherapy had lower oocyte yields than those who were mutation negative or untested (J Clin Oncol 2010; 28:240). Now, two groups of investigators have explored the role of BRCA1/2 mutations in amenorrhea after breast cancer therapy and in natural menopause.

Valentini and colleagues conducted an international study of 2121 young breast cancer patients; 1954 were BRCA1/2 carriers, and 167 were noncarriers. The probability of chemotherapy-induced amenorrhea among carriers increased with age at diagnosis: 7.2% at age ≤30, 33% at age 31 to 44, and 79% at age ≥45 (P<0.001 for trend). Also, the probability of induced amenorrhea was higher for carriers who received tamoxifen plus chemotherapy versus chemotherapy alone (52% vs. 29%; P<0.001) and for BRCA2 versus BRCA1 carriers (46.8% vs. 32.7%; P=0.001). Age-related trends were similar for noncarriers, indicating that carriers were not at higher risk for induced amenorrhea.

Collins and colleagues studied 1840 women who were either BRCA-mutation carriers or noncarriers from families segregating a BRCA1 or BRCA2 mutation. The authors found no difference in age-specific incidence of natural menopause between mutation carriers and noncarriers.