Early Menopause and Infertility in Females after Treatment for Childhood Cancer Diagnosed in 1964-1988 in Ontario, Canada

Abstract

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.