Contraceptive Use in Premenopausal Women With Early Breast Cancer

Author:

Lambertini Matteo12,Massarotti Claudia34,Havas Julie5,Pistilli Barbara6,Martin Anne-Laure7,Jacquet Alexandra7,Coutant Charles8,Coussy Florence9,Mérimèche Asma Dhaini10,Lerebours Florence11,Rousset-Jablonski Christine12,Jouannaud Christelle13,Rigal Olivier14,Fournier Marion15,Soulie Patrick16,Franzoi Maria Alice6,Del Mastro Lucia12,Partridge Ann H.17,André Fabrice56,Vaz-Luis Ines56,Di Meglio Antonio56

Affiliation:

1. Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy

2. Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy

3. Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health, School of Medicine, University of Genova, Genova, Italy

4. Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy

5. Institut National de la Sante et de la Recherche Medicale Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France

6. Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France

7. Unicancer, Paris, France

8. Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France

9. Department of Medical Oncology, Institut Curie, Paris, France

10. Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre Les Nancy, France

11. Department of Medical Oncology, Institut Curie, Saint-Cloud, France

12. Department of Surgery, Centre Léon Berard, Lyon, France

13. Department of Medical Oncology, Institut Jean Godinot, Reims, France

14. Department of Medical Oncology, Centre Henri Becquerel, Rouen, France

15. Department of Surgical Oncology, Institut Bergonié, Bordeaux, France

16. Department of Medical Oncology, Institut de Cancérologie de L’ouest-Paul Papin, Angers, France

17. Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts

Abstract

ImportanceAs life span has increased among patients with cancer, survivorship has become an important component of breast cancer care. Among survivorship concerns, adequate contraceptive counseling is needed for premenopausal patients who are not seeking to become pregnant.ObjectiveTo examine contraceptive use and chosen methods and to assess factors associated with contraceptive use over time in patients with early breast cancer.Design, Setting, and ParticipantsThe Cancer Toxicity (CANTO) study was a multicenter nationwide prospective cohort study that enrolled women diagnosed with stage I to stage III breast cancer in France between March 2012 and December 2017. This analysis included 2900 premenopausal women who were 50 years of age or younger at diagnosis. Data were analyzed from July 2020 to July 2022.ExposuresContraceptive use and method at diagnosis, shortly after the end of primary treatment (year 1), and during follow-up (year 2).Main Outcomes and MeasuresContraceptive use and methods were longitudinally evaluated at diagnosis, year 1, and year 2 after breast cancer diagnosis. Multivariable logistic regression models were used to assess the associations of clinical, socioeconomic, treatment, adverse effect, and patient-reported outcome variables with contraceptive use after diagnosis.ResultsA total of 2900 patients (mean [SD] age, 43.1 [5.6] years) were included in the analysis; 2050 of 2894 women (70.8%) received chemotherapy, and 2305 of 2880 women (80.0%) received endocrine therapy. After diagnosis, 1182 of 2625 patients (45.0%) at year 1 and 1553 of 2363 patients (65.7%) at year 2 reported consulting with a gynecologist in the previous year. At diagnosis, 1487 of 2744 patients (54.2%) reported contraceptive use, with most patients (921 of 1470 women [62.7%]) using hormonal methods. The use of contraception significantly decreased after diagnosis (911 of 2342 patients [38.9%] at year 1 and 808 of 1961 patients [41.2%] at year 2; P < .001 for trend), when most patients (848 of 900 women [94.2%] at year 1 and 767 of 805 women [95.3%] at year 2) reported use of nonhormonal methods; these methods were primarily reversible mechanical approaches (copper intrauterine devices: 656 of 848 patients [77.4%] at year 1 and 577 of 767 patients [75.2%] at year 2; male condoms: 115 of 848 patients [13.6%] at year 1 and 110 of 767 patients [14.3%] at year 2). In the multivariable model, factors significantly associated with contraceptive use at year 1 included using contraception at diagnosis (adjusted odds ratio [aOR], 4.02; 95% CI, 3.15-5.14), being younger (aOR, 1.09; 95% CI, 1.07-1.13 per decreasing year), having better sexual function (aOR, 1.13; 95% CI, 1.07-1.19 per 10-point increment), having children (aOR, 4.21; 95% CI, 1.80-9.86), reporting the presence of leukorrhea (aOR, 1.32; 95% CI, 1.03-1.70), receiving tamoxifen treatment alone (aOR, 1.39; 95% CI, 1.01-1.92), and consulting with a gynecologist in the previous year (aOR, 1.29; 95% CI, 1.02-1.63). Similar factors were associated with contraceptive use at year 2, with the addition of partnered status (aOR, 1.61; 95% CI, 1.07-2.44).Conclusions and RelevanceFindings from this study support the importance of raising awareness and improving targeted contraceptive counseling for premenopausal women with early breast cancer.

Publisher

American Medical Association (AMA)

Subject

General Medicine

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