American Journal of Epidemiology Vol. 150, No. 3: 245-254
Copyright © 1999 by The Johns Hopkins University School of Hygiene and Public Health
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Early Menopause and Infertility in Females after Treatment for Childhood Cancer Diagnosed in 1964–1988 in Ontario, Canada
1Division of Preventive Oncology, Cancer Care Ontario Toronto, Ontario, Canada
2Department of Public Health Sciences, University of Toronto Toronto, Ontario, Canada
3Faculty of Nursing, University of Toronto Toronto, Ontario, Canada
This study was conducted to determine the risk of menopause and infertility in female childhood cancer survivors who received abdominal-pevic radiation and/or chemotherapy with alkylating agents in comparison with those who were treated by nonsterilizing surgery only. Females who were diagnosed in 1964–1988 before age 20 years with a histologically confirmed mallganancy and who had survived for at least 5 years, had attained age 18, and were alive at time of study were identified through the Ontario Cancer Registry. Reproductive outcomes were ascertained by a telephone-administered questionnaires, and treatment data were abstracted from medical records for 830 subjects aged 18–49 years; 719 survivors who were non menopausal at the end of treatment were included inthe analyses. Survivors who received both alkylating agents and addorminal-pevic radiation were more likely to be postmenopausal than were those who underwent surgery (risk ratio =2.58;95% confidence interval: 1.14, 5.80). Women treated with abdominal-pelvic radiation alone had a fertility deficit of 23% compared with those inthe surgery group; the deficit was restricted to women diagnosed postpuberty. Risks of menopause and infertility increased with increasing dose of addominal-pelvic radiation and amount of alkylating agent. Am J Epidemiol 1999; 150: 245–54.
alkylating agents; child; cohort studies; drug therapy; infertility; menopause; neoplasms; radiotherapy
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