For young women with breast cancer (BC), contraceptive options are limited since estrogens are generally avoided due to the hormonal responsive of most tumors. However, little is known about how a BC diagnosis affects contraceptive choices.
The CANTO (Cancer Toxicity) study was a French, multicenter, prospective cohort trial conducted from March 2012 to December 2017 that enrolled women aged 50 years and younger who were diagnosed with stage I to III BC. The purpose of this study was to examine chosen contraceptive methods at the time of diagnosis and to assess factors associated with contraceptive use during a 2-year follow-up period. Postmenopausal women, those aged older than 50 years, those who were menopausal at the time of the BC diagnosis, and those with incomplete information on contraceptive use were excluded from analysis.
Patient assessment at the time of diagnosis included sociodemographic, clinicobehavioral, and tumor- and treatment-related characteristics. Longitudinal evaluation was conducted at study entry, approximately 1 year after diagnosis, 3 to 6 months following primary treatment, and approximately 2 years after diagnosis.
Quality of life (QOL) following treatment was assessed using the European Organization for Research and Treatment of Cancer (EORTC) QOL Questionnaire (OLO)-Core 30 (OLO-C30), which measures QOL among cancer patients. It is scored on a scale of 0 to 100 points with higher scores for global health indicating better QOL and better function represented by higher scores on functional scales that assessed physical, emotion, cognitive, social, and role functioning. EORTC QLQ (QLQ BR23), a 23-question module designed to assess QOL specifically in BC patients that also enquires about sexual function, was utilized in this study. Gynecological symptoms (vaginal dryness, leukorrhea, and hot flashes) were assessed with leukorrhea serving as a measure of vaginal health.
A total of 2,900 premenopausal women with early BC (mean age at diagnosis was 43.1 years) were included in the study. At diagnosis, 54.2% reported using contraception. This decreased to 38.9% at Year 1 and increased slightly to 41.2% in Year 2. The trend was statistically significant (P <.01). While 62.7% used hormonal methods at the time of diagnosis, this dropped to only 5.8% at Year 1 and 4.7% at Year 2. Almost all women (94.2%) had shifted to nonhormonal methods by Year 1 and Year 2 (94.2% and 95.3%, respectively). Reversible mechanical methods were the nonhormonal methods most often used (91.0% in Year 1 and 89.7% in Year 2), including copper intrauterine devices (77.4% in Year 1 and 75.2% in Year 2) and male condoms (13.6% in Year 1 and 14.3% in Year 2). Some women used multiple contraceptive methods. A minority opted for nonreversible methods (4.2% in Year 1 and 3.7% in Year 2), which included Essure implant (that was taken off the market in 2018), hysterectomy, ovariectomy, salpingectomy, or both ovariectomy and salpingectomy.
The factors associated with contraceptive use in Years 1 and 2 in multivariant analyses included being on a contraceptive at diagnosis, being younger, having better sexual functioning, having leukorrhea, using tamoxifen monotherapy, and visiting a gynecologist in the previous year.
Having children was also significant in Year 1, whereas having a partner was significant in Year 2. Contraceptive use was associated with a more favorable effect on various components of QOL (e.g., body image, global health status, physical function, emotional function, role function, and social function) in univariant analyses in both Years 1 and 2; sexual enjoyment and cognitive function were also more positively affected in contraceptive users in Year 1 compared with nonusers.
This study provides useful information to help guide the discussion on sexual health in young women following a BC diagnosis. This is especially important given the contraceptive prescriptive privileges of pharmacists in several states as well as the growing prevalence of BC in young women.
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