Breast cancer is very common and seen in both premenopausal and postmenopausal women. Research into prevention, better screening, and more effective treatments is occurring continually, and changes are translated into clinical practice relatively quickly. It is important for women's health care providers to have an understanding of breast cancer treatments and the gynecologic side effects. For premenopausal women interested in fertility, options should be discussed prior to chemotherapy. Issues pertaining to pregnancy after breast cancer should be discussed in a multidisciplinary fashion, involving the obstetrician/gynecologist, breast surgeon, and oncologist. Ovarian suppression is often used as part of breast cancer treatment in premenopausal women with hormone positive disease, and menopausal symptoms may be severe. Hormonal therapies including tamoxifen and the aromatase inhibitors are used in the treatment of hormone positive breast cancers. Each of these drugs has a variety of gynecologic implications. Understanding the options for treatment for menopausal complaints in breast cancer patients is important for women's health providers. Although most breast cancers are sporadic, a small percentage will be due to mutations in the BRCA genes. It is imporatant for women's health providers to take an appropriate family history and refer to genetic counselors for possible testing when hereditary cancer is suspected. This review focuses on the various women's health issues pertaining to breast cancer and treatment.
Obstetricians & Gynecologists, Family Physicians
After completion of this article, the reader should be able to identify potential impact of breast cancer treatment on a women's future fertility, organize a logical approach to the gynecological care of a patient on tamoxifen for breast cancer, and describe the gynecological factors of importance to women who are BRCA1/2 positive.
*Clinical Professor, Department of Obstetrics, Gynecology, and †Director, Women's Cancer Care Program, Carol Franc Buck Breast Care Center and UCSF Women's Health, ‡Gynecologic Nurse Practitioner, UCSF Women's Health, Reproductive Sciences, University of California, San Francisco, San Francisco, California
Chief Editor’s Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA Category 1 Credits™ can be earned in 2009. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.
Dr. Goldman has disclosed that she was/is the recipient of salary support from AstraZeneca and she was/is a consultant for Wyeth Pharmaceutical. Dr. O'Hair has disclosed that she has no financial relationships with or interests in any commercial companies pertaining to this educational activity.
The Faculty and Staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.
The authors have disclosed that Paroxetene, Venlafaxene, Vagifem, Testosterone, Estring, Clonidine, Gabapentin, Tibilone, and Buproprion have not been approved by the U.S. Food and Drug Administration for use in the treatment of menopausal symptoms in breast cancer survivors. Please consult product labeling for the approved usage of this drug or device.
Lippincott Continuing Medical Education Institute, Inc. has identified and resolved all faculty conflicts of interest regarding this educational activity.
Reprint requests to: Mindy Goldman, MD, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA. E-mail: firstname.lastname@example.org.