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Does lifetime exposure to hormones predict pretreatment cognitive function in women before adjuvant therapy for breast cancer?

Bender, Catherine M. PhD, RN, FAAN1; Sereika, Susan M. PhD1; Ryan, Christopher M. PhD1,2; Brufsky, Adam M. MD, PhD2; Puhalla, Shannon MD2; Berga, Sarah L. MD3

Menopause: The Journal of The North American Menopause Society: September 2013 - Volume 20 - Issue 9 - p 905–913
doi: 10.1097/GME.0b013e3182843eff
Original Articles

Objective Women with breast cancer have been found to have poorer cognitive function before the initiation of systemic adjuvant therapy than their age- and education-matched counterparts. The basis for this may partly include hormone exposure during the course of a woman’s life.

Methods We compared cognitive function between postmenopausal women with breast cancer before the initiation of systemic adjuvant therapy and healthy age- and education-matched postmenopausal women and examined whether factors related to lifetime exposure to hormones predicted cognitive function before therapy.

Results We found that, compared with healthy women, women with breast cancer had poorer memory (P = 0.05) and attention (P = 0.006). Controlling for the covariates age and estimated verbal intelligence, we found that factors related to greater lifetime hormone exposure (oral contraceptive use, greater years since menopause, and longer duration of hormone therapy) predicted cognitive function (executive function, verbal learning and memory, attention, psychomotor efficiency, and visual sustained attention) in women with and without breast cancer but did not explain the differences in cognitive function observed at pretreatment in women with breast cancer.

Conclusions Other factors may explain the poorer pretreatment cognitive function in women with breast cancer, including persistent effects of surgical operation and anesthesia, sleep problems, and tumor-related factors. Additional studies are needed to explicate the basis of poorer pretherapy cognitive function in this population.

From the 1University of Pittsburgh School of Nursing, Pittsburgh, PA; 2University of Pittsburgh School of Medicine, Pittsburgh, PA; and 3Wake Forest University School of Medicine, Winston-Salem, NC.

Received September 25, 2012; revised and accepted December 20, 2012.

Funding/support: This research was supported by National Cancer Institute grant R01 CA 107408.

Financial disclosure/conflicts of interest: S.L.B. reports consultancies for Noven Pharmaceuticals medical advisory board and Shionogi Inc. All other authors report no conflicts of interest.

Address correspondence to: Catherine M. Bender, PhD, RN, FAAN, University of Pittsburgh School of Nursing, Suite 450, 3500 Victoria Street, Pittsburgh, PA 15261. E-mail:

© 2013 by The North American Menopause Society.