Obesity may decrease the amenorrhea associated with chemotherapy in premenopausal breast cancer patients
Authors: K. Altundag, O. Altundag, P. Morandi, M. Gunduz
Journal: Annals of Oncology (2005)

We read with great interest the article by Berclaz et al. [1.Berclaz G. Li S. Price K.N. et al.Body mass index as a prognostic feature in operable breast cancer: the International Breast Cancer Study Group experience.Ann Oncol. 2004; 15: 875-884Abstract Full Text Full Text PDF PubMed Scopus (212) Google Scholar], 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 [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: 43-48Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar]. 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. [3.Mehta R.R. Beattie C.W. Das Gupta T.K. Endocrine profile in breast cancer patients receiving chemotherapy.Breast Cancer Res Treat. 1992; 20: 125-132Crossref PubMed Scopus (60) Google Scholar] 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. We read with great interest the article by Berclaz et al. [1.Berclaz G. Li S. Price K.N. et al.Body mass index as a prognostic feature in operable breast cancer: the International Breast Cancer Study Group experience.Ann Oncol. 2004; 15: 875-884Abstract Full Text Full Text PDF PubMed Scopus (212) Google Scholar], 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 [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: 43-48Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar]. 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. [3.Mehta R.R. Beattie C.W. Das Gupta T.K. Endocrine profile in breast cancer patients receiving chemotherapy.Breast Cancer Res Treat. 1992; 20: 125-132Crossref PubMed Scopus (60) Google Scholar] 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.