Managing menopause after cancer

The Lancet, Journal Year: 2024, Volume and Issue: 403(10430), P. 984 - 996

Published: March 1, 2024

Language: Английский

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British Gynaecological Cancer Society (BGCS) ovarian, tubal and primary peritoneal cancer guidelines: Recommendations for practice update 2024

European Journal of Obstetrics & Gynecology and Reproductive Biology, Journal Year: 2024, Volume and Issue: 300, P. 69 - 123

Published: June 21, 2024

Recommendations are graded as per the Royal College of Obstetricians and Gynaecologists document, Clinical Governance Advice No. 1: Guidance for Development RCOG Green-top Guidelines, available on website at (see Supplementary Tables 1 2 below www.rcog.org.uk/rcog). Definitions certainty evidence based formal GRADE assessment within systematic reviews given in Table 3 [682GRADE Handbook.: Working Group; 2013. Available from: https://gdt.gradepro.org/app/handbook/handbook.html#h.svwngs6pm0f2.Google Scholar]. This guideline is healthcare professionals who care women, non-binary trans people with different types tubo-ovarian cancer. Within this document we use terms woman women's health. However, it important to acknowledge that not only women whom necessary access health reproductive services order maintain their gynaecological wellbeing. Gynaecological delivery must therefore be appropriate, inclusive sensitive needs those individuals whose gender identity does align sex they were assigned birth [1Gribble KD, Bewley S, Bartick MC, Mathisen R, Walker Gamble J, et al. Effective Communication About Pregnancy, Birth, Lactation, Breastfeeding Newborn Care: The Importance Sexed Language. Frontiers Global Women's Health. 2022;3.Google development process detailed below:•Chair, officers, council guidelines committee (GC) nominated a lead each topic;•Lead then identified team called (GT) develop 1st draft;•1st draft was submitted GC;•GC approved recommended changes;•Changes accepted by GT produced guidelines;•2nd members officers;•Council officers 2nd GC GT;•3rd sent BGCS membership, national international peer review public consultation, including relevant charities patient support groups;•GT made changes comments;•Final officers. Ovarian cancer remains 6th most common females UK 7,495 new cases annually (2016–18), equating lifetime risk 50 [2Ovarian Cancer Statistics [Internet]. 2017 [cited 09.02.2022]. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/ovarian-cancer.Google crude all-age incidence rate 22.8/100,000 (2016–18). age population diagnosis has resulted peak rising from 60-64 years 75–79 years. rates have been falling over past decade, greatest fall being seen 60 69-year-old population, 60.7/100,000 2001–3, 46.7/100,000 2016–18. No clear differences deprivation [3Cancer Intelligence Team Research UK. Based method reported National Network Deprivation England Incidence, 1996-2010 Mortality, 1997-2011(link external) . Using data 2013-2017 (Public Health England) (Office Statistics) Indices Multiple 2015 income domain quintile, type, sex, five-year band. 2020.Google ovarian appears lower Asian, Black Mixed/Multiple ethnicity populations compared White ethnic group [4Delon C. Brown K.F. Payne N.W.S. Kotrotsios Y. Vernon S. Shelton J. Differences broad England, 2013–2017.Br J Cancer. 2022; 126: 1765-1773Crossref PubMed Scopus (32) Google Along changing rates, mortality also changed time. 85–89 years, nearly half all deaths occur patients 75 (2017–19). Mortality decreased 23 % five decades, accelerated few now 12.2/100,000 2017–19, 4142 (2017–19), projected even further [5Smittenaar C.R. Petersen K.A. Stewart K. Moitt N. projections until 2035.Br 2016; 115: 1147-1155Crossref (347) 60–69-year group, 42.2/100,000 (1988–90) 24.5/100,000 Many factors contribute landscape, example increasing contraception use, risk-reducing surgery evolving treatment options; these will discussed subsequent chapters. There great need accurate Registry data, without which would possible explore understand trends exemplified BGCS, Target Action NCRAS Audit Feasibility Pilot [6Ovarian Study Group Pilot. Disease Profile England: mortality, stage survival ovary, fallopian tube primary peritoneal carcinomas. Public London2020 10 Jan 2020Google currently no role screening considered low or level (Grade A) surveillance high shown good performance characteristics significant downstaging. there information demonstrating benefit. Although an alternative may potential considering four-monthly using longitudinal biomarker algorithm, interim management strategy delaying surgery, following careful counselling. C) Women carry pathogenic likely variant moderate susceptibility gene (BRCA1, BRCA2, RAD51C, RAD51D, BRIP1, PALB2) should offered informed counselling bilateral salpingo-oophorectomy (RRSO) prevention, once family complete. Lynch syndrome form total hysterectomy reduce endometrial timing individualised, gene-specific risk, Risk-reducing early salpingectomy delayed oophorectomy (RRESDO) two-stage surgical prevention procedure increased undertaken context research trial. equal above 4–5 can reducing (RRSO). B) All reviewed specialist, multidisciplinary team, discuss surgery. A SEE-FIM protocol used histopathological undergoing RRSO. diagnosed STIC invasive histology referred specialist MDT consideration options. If isolated alone, cytology negative imaging normal, completion strongly advised. For prophylactic oophorectomy, HRT, consultation joint BGCS/British Menopause Society recommended. personal history breast (or contra-indications HRT) undergo leads iatrogenic menopause HRT till average natural menopause. Maintaining compliance minimise detrimental consequences premature B). usually contraindicated avoided ER + PR Some (e.g. BRIP1/Lynch syndrome). beyond governed same principles population-based risk. C). Opportunistic time intra-abdominal completed family. opportunistic recruited prospective studies long-term follow up. D) aim program identify condition, condition problem, point whereby timely intervention make decisions improve outcomes [7Shieh Eklund M. Sawaya G.F. W.C. Kramer B.S. Esserman L.J. Population-based cancer: hope hype.Nat Rev Clin Oncol. 13: 550-565Crossref (96) Screening universal, ill-defined (for certain age) enrolled case finding defined screened [8Moyer VA, Force USPST. cervical U.S. Preventive Services Task recommendation statement. Ann Intern Med. 2012;156(12):880-91, W312.Google programme formalised Wilson Jungner 1968 [9Wilson J.M. Y.G. Principles practice mass disease.Bol Oficina Sanit Panam. 1968; 65: 281-393PubMed Committee (UK NSC) established criteria guidance evaluating [10UK Committee. Criteria United Kingdom: 2022 [Available https://www.gov.uk/government/publications/evidence-review-criteria-national-screening-programmes/criteria-for-appraising-the-viability-effectiveness-and-appropriateness-of-a-screening-programme.Google Twin suggest inherited genetic around 22 towards [11Lichtenstein P. Holm N.V. Verkasalo P.K. Iliadou A. Kaprio Koskenvuo al.Environmental heritable causation cancer–analyses cohorts twins Sweden, Denmark, Finland.N Engl 2000; 343: 78-85Crossref (3354) BRCA1/BRCA2 genes account known inheritable component Around 15–22 cancers caused variants (called 'pathogenic variants' 'PVs') (CSGs) [12Walsh T. Casadei Lee M.K. Pennil C.C. Nord A.S. Thornton A.M. al.Mutations 12 ovarian, tube, carcinoma massively parallel sequencing.Proc Natl Acad Sci U S 2011; 108: 18032-18037Crossref (775) Scholar, 13Chandrasekaran D. Sobocan Blyuss O. Miller R.E. Evans Crusz S.M. al.Implementation Multigene Germline Parallel Somatic Genetic Testing Epithelial Cancer: SIGNPOST Study.Cancers (Basel). 2021; 13Crossref (26) These include BRCA1, PALB2 MMR (mismatch repair) genes. Together PVs up 40 majority Caucasian populations. syndrome, deficiency mismatch repair system, [14Ryan N.A. McMahon R.F. Ramchander N.C. Seif M.W. D.G. Crosbie E.J. gynaecologist.Obstet Gynaecol. 23: 9-20Crossref Scholar], second hereditary cause associated 0.5–2 [15Crosbie Ryan N.A.J. McVey R.J. Lalloo F. Bowers Green al.Assessment cancer.J Med Genet. 58: 687-691Crossref (13) 16Pal Akbari M.R. Sun J.H. Fulp Thompson Z. al.Frequency mutations study cancer.Br 2012; 107: 1783-1790Crossref (65) Of note, biology syndrome-associated often earlier less metastasise [17Ryan Pathological features clinical behavior cancer.Gynecol 2017; 144: 491-495Abstract Full Text PDF (69) list CSGs summarised 1. In addition moderate/high penetrance CSGs, number SNPs odds ratios (OR) varying 0.8 1.4. 36 validated through Genome-wide association (GWAS). explain 6 heritability [18Kar S.P. Berchuck Gayther S.A. Goode E.L. Moysich K.B. Pearce C.L. al.Common Variation Susceptibility Current Insights Future Directions.Cancer Epidemiol Biomarkers Prev. 2018; 27: 395-404Crossref (29) combined into polygenic score (PRS) refine stratification, both general high-risk leading improved estimation more decision making respect targeted [19Barnes D.R. Rookus M.A. McGuffog L. Leslie G. Mooij T.M. Dennis al.Polygenic scores epithelial risks carriers BRCA1 BRCA2 variants.Genet 2020; 22: 1653-1666Abstract (81) 20Dareng E.O. Tyrer J.P. Barnes Jones Yang X. Aben K.K.H. modeling prediction risk.Eur Hum 30: 349-362Crossref (21) 21Lee Gentry-Maharaj Mavaddat al.Comprehensive model incorporating epidemiological factors.J 59: 632-643Crossref (30) 22Pearce Stram D.O. Ness R.B. D.A. Roman L.D. Templeman al.Population distribution States.Cancer 2015; 24: 671-676Crossref Having strong factor affecting first degree relative (FDR) increase developing threefold [23Jervis Song H. Dicks E. Harrington al.Ovarian familial tumour subtypes variants.J 2014; 51: 108-113Crossref (50) Higher two three FDRs [24Sutcliffe Pharoah P.D. Easton D.F. Ponder B.A. families cancer.Int 87: 110-117Crossref (0) Epigenetics too play future. Recently, DNA methylation signature obtained cells predict future [25Barrett J.E. I. Reisel Herzog Chindera al.The methylome presence cancer.Nat Commun. 448Crossref (18) Scholar].Table 1Cancer genes, risks, surgery.GeneOvarian (CI)Breast riskEndometrial riskRecommended surgeryAge (years)EvidenceReference(s)HBOC HOCBRCA1High 44 (36–53 %)HighRRSO≥35-40Strong26Kuchenbaecker Hopper J.L. Phillips Roos-Blom M.J. al.Risks Breast, Ovarian, Contralateral Breast Mutation Carriers.JAMA. 317: 2402-2416Crossref (1791) ScholarBRCA2High 17 (11–25 %)HighRRSO≥40Strong26Kuchenbaecker ScholarPALB2Moderate∼5% (2–10 %)HighRRSO>45–50Moderate27Yang Doroszuk Schneider Allen Decker B. al.Cancer Risks Associated With Pathogenic Variants: An International 524 Families.J 38: 674-685Crossref (260) ScholarRAD51CModerate- High 11 (6–21 %)ModerateRRSO>45Strong28Yang Engel Hahnen Auber Variants RAD51C RAD51D.J Inst. 112: 1242-1250Crossref (102) ScholarRAD51DModerate- 13 (7–23 Scholar#ATMLow3–4 %ModerateNot recommendedNAInsufficient29Lu H.M. Li M.H. Hoiness R. Wu al.Association Cancers Predisposition Genes Identified Large-Scale Sequencing.JAMA 2019; 5: 51-57Crossref (129) 30Lilyquist LaDuca Polley Davis B.T. Shimelis Hu large series clinically ascertained tested multi-gene panels reference controls.Gynecol 147: 375-380Abstract (95) 31Kurian A.W. Hughes Handorf E.A. Gutin Hartman A.R. al.Breast Penetrance Estimates Derived From Multiple-Gene Sequencing Results Women.JCO Precis 1-12Crossref (113) 32Norquist B.M. Harrell M.I. Brady M.F. Walsh Gulsuner al.Inherited Mutations Carcinoma.JAMA 2: 482-490Crossref ScholarBRIP1Moderate 6–8 %LowRRSO>45Strong33Ramus SJ, H, E, JP, Rosenthal AN, Intermaggio MP, BARD1, PALB2, NBN 2015;107(11).Google ScholarLynch SyndromeMLH1Moderate- High11% (7.4–19.7 %)HighRRSO Hysterectomy>35–40Strong34Moller Prospective Syndrome Database (PLSD) - cumulative age, variant, 2019 http://www.lscarisk.org/.Google 35Moller Seppala T.T. Bernstein Holinski-Feder Sala Gareth path_MMR age: report Database.Gut. 67: 1306-1316Crossref (382) Scholar†MSH2High 17.4 (11.8–31.2 ScholarMSH6Moderate- High10.8 (3.7–38.6 Scholar*PMS2Low (0.5–––43.3 %)ModerateHysterectomy only*>45–50Moderate34Moller ScholarFamily risk>4–5 %LowLowRRSO≥50Strong / Moderate23Jervis 24Sutcliffe ScholarHBOC: cancer; HOC; RRSO: salpingo-oophorectomy.*Routine salpingo PMS2 BSO post-menopausal after pros cons if menopause.#Risks ATM its own lie current thresholds RRSO Family plays part making. Cases greater expertise.†EPCAM deletion result silencing MSH2 gene. It hypothesized similar but dependent type EPCAM deletion. individual basis geneticist, confirm whether cancer/ovarian cacner risks.In where complex difficult, advice expertise like geneticist gynaecologist/gynae-oncologist special interest sought. Open table tab HBOC: salpingo-oophorectomy. *Routine #Risks expertise. †EPCAM risks. Environmental ovulations [36Reid Permuth J.B. Sellers T.A. Epidemiology review.Cancer Biol 14: 9-32Crossref (994) nulliparity, menarche late Factors ovulation, such oral contraceptives, [37Wu A.H. Tseng Jotwani Patel al.Timing births contraceptive influences risk.Int 141: 2392-2399Crossref (20) 38Collaborative Epidemiological Studies C Beral V. Doll Hermon Peto Reeves contraceptives: collaborative reanalysis 45 23,257 87,303 controls.Lancet. 2008; 371: 303-314Abstract (625) Increasing parity, feeding later protective against 39Gaitskell Pirie G.K. al.Histological parity breastfeeding Million Study.Int 142: 281-289Crossref (46) Tubal ligation [40Cibula Widschwendter Majek Dusek meta-analysis.Hum Reprod Update. 17: 55-67Crossref (216) 41Gaitskell cohort: Substantial variation histological type.Int 138: 1076-1084Crossref (40) Scholar] [42Falconer Yin Gronberg Altman salpingectomy: nationwide study.J 107Crossref (309) 43Falconer Salehi Association between pelvic inflammatory disease cancer.Eur 145: 38-43Abstract (9) 44Madsen Baandrup Dehlendorff Kjaer S.K. borderline tumors: case-control study.Acta Obstet Gynecol Scand. 94: 86-94Crossref Case control explored impact benign conditions Endometriosis grade serous, endometrioid cell [45Pearce Rossing Near Webb P.M. endometriosis pooled analysis case–control studies.Lancet 385-394Abstract (721) 46Hermens van Altena Nieboer T.E. Schoot B.C. Vliet Siebers A.G. al.Incidence clear-cell proven endometriosis: ENOCA cohort study.Am Gynecol. 223(1):107: e1-e11Google 47Kvaskoff Mahamat-Saleh Farland L.V. Shigesi Terry K.L. Harris H.R. al.Endometriosis 393-420Crossref (127) found tumours, [48Rasmussen C.B. Faber M.T. Jensen Hogdall Blaakaer al.Pelvic tumors.Cancer Causes Control. 2013; 1459-1464Crossref (34) 49Rasmussen Albieri Andersen K.K. Increased tu

Language: Английский

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Sexuality After Cancer as an Unmet Need: Addressing Disparities, Achieving Equality

American Society of Clinical Oncology Educational Book, Journal Year: 2022, Volume and Issue: 42, P. 11 - 17

Published: June 3, 2022

One extremely important and often neglected aspect of cancer care is sexuality. Sexuality inherently a human trait, this does not cease to be true after diagnosis. Multiple domains comprise sexuality, all are at risk from its treatment. Despite the importance sexual health, it still represents an unmet need in United States internationally. The disparities meeting health needs women with extend beyond issues related genitourinary symptoms menopause pleasure; we propose that extends toward gender minorities. Therefore, focus on delivery for people emphasis women, low- middle- income countries, marginalized

Language: Английский

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Sexual Health after a Breast Cancer Diagnosis: Addressing a Forgotten Aspect of Survivorship

Journal of Clinical Medicine, Journal Year: 2022, Volume and Issue: 11(22), P. 6723 - 6723

Published: Nov. 14, 2022

Breast cancer is the most common in women. The life expectancy after a breast diagnosis improving steadily, leaving many more persons with long-term consequences of treatment. Sexual problems are concern for survivors yet remain overlooked both clinical setting and research literature. Factors that contribute to sexual health concerns biopsychosocial, as barriers addressing treating these concerns. needs treatment may vary by anatomy gender. Multidisciplinary management comprise lifestyle modifications, medications, aids such vibrators, counseling, referrals pelvic physical therapy specialty care. In this article, we review contributing factors, screening, difficulties cisgender female survivors. More information needed better address whose sexual/gender identity differs from

Language: Английский

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Sexual Health in Women Affected by Gynecologic or Breast Cancer

Obstetrics and Gynecology, Journal Year: 2024, Volume and Issue: unknown

Published: Jan. 11, 2024

Sexual health problems are prevalent among women affected by gynecologic or breast cancer. It is important to understand the effects cancer treatment can have on sexual and tools necessary identify treat problems. This Clinical Expert Series discusses practical methods for routinely screening dysfunction reviews options We review limitations of current literature in addressing sexually gender minoritized communities. Finally, we discuss appropriate timing referrals experts, physical therapists, sex therapists. Multiple resources available both patients clinicians included.

Language: Английский

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The Impact of Vulvar Cancer on Psychosocial and Sexual Functioning: A Literature Review

Cancers, Journal Year: 2021, Volume and Issue: 14(1), P. 63 - 63

Published: Dec. 23, 2021

Women who are diagnosed and treated for vulvar cancer at higher risk of psychological distress, sexual dysfunction dissatisfaction with partner relationships. The aim this article is to provide a review the psychological, relational issues experienced by women in order highlight importance issue improve quality care offered these patients. A literature was performed using PubMed, CINAHL, PsycINFO, Cochrane Library. results presented as narrative synthesis massive impact cancer: depressive anxiety symptoms were more frequent women, may have negative effect on sexuality from physical, behavioural point view. Factors that negatively affect women's lives shame, insecurity or difficulties self-care daily activities. This highlights psychosocial psychosexual faced cancer, although studies needed better investigate field interest identify strategies relieve their distress. Care providers should implement an integrated model help recognise address unmet needs.

Language: Английский

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Sexual Health in Adolescents and Young Adults With Cancer

Journal of Clinical Oncology, Journal Year: 2023, Volume and Issue: 42(6), P. 717 - 724

Published: Oct. 19, 2023

Sexual health (SH), an integral aspect of overall and quality life, can be negatively affected by cancer treatment. SH is influenced biological, psychological, social, cultural factors, and, for adolescents young adults (AYAs), developmental factors. The AYA population (age 15-39 years) diverse in terms psychosexual development, interpersonal relationships, varying levels independence, resulting unique needs this population. AYAs with are particularly vulnerable to unmet related contraception infection prevention, sexual function, body image, romantic/sexual relationships. dysfunction during after treatment reported 30%-100% survivors. Clinical guidelines recommend discussing screening but currently lack specifics regarding interventions strategies incorporating into clinical care. Research priorities include improved provider-AYA communication SH, standardization measures tools, infrastructure support the across pediatric adult environments, engagement gender minority research. As field evolves, need tailored that address multidimensional aspects SH.

Language: Английский

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Investigating sexual health after breast cancer by longitudinal assessment of patient-reported outcomes

ESMO Open, Journal Year: 2024, Volume and Issue: 9(2), P. 102236 - 102236

Published: Feb. 1, 2024

•Sexual concerns are frequent at BC diagnosis and seem to increase or persist in the after-treatment period.•Less than 50% of patients with reported sexual consulted proper supportive care specialists.•This large longitudinal cohort study helps identify that more likely report persistent concerns.•A proactive evaluation management health must exist across continuum. BackgroundSexual a major unaddressed need among survivors breast cancer (BC) significant negative effects on quality life. We longitudinally analyzed over time, using patient-reported outcomes.MethodsPatients stage I-III prospectively included from CANcer TOxicity (CANTO) provided data diagnosis, then 1, 2, 4 years afterward. Sexual outcomes poor body image (score ≤91/100), functioning (≤16/100), enjoyment (≤66/100), inactivity (EORTC QLQ-B23). Multivariate generalized estimating equation models assessed associations after adjusting for age, sociodemographic, tumor, treatment, clinical characteristics.ResultsNearly 78.1% 7895 least one concern between years' follow-up. Over proportion reporting either increased remained constant diagnosis. Less half (46%, range 11.4-57) use strategies, including gynecological psychological consultations (range 11.4-57.4). Factors consistently associated up already same [odds ratio (OR)poor 3.48 [95% confidence interval (CI) 3.11-3.89]; ORsexual 9.94 (95% CI 8.84-11.18), ORpoor function 9.75 8.67-10.95), 3.96 3.34-4.69)], endocrine therapy [ORpoor 1.15 1.01-1.31); 1.19 1.02-1.39), 1.17 1.01-1.37), 1.23 1.00-1.53)], depression 2.00 1.72-2.34); 1.66 1.40-1.97), 1.69 1.43-2.00), 1.94 1.50-2.51)]. Outcome-specific were also identified.ConclusionsSexual frequent, persistent, insufficiently addressed. Pretreatment concerns, therapy, emotional distress commonly factors. A continuum is needed, promptly suitable multidisciplinary counseling, referral, interventions. outcomes. Patients characteristics. Nearly identified.

Language: Английский

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Exploring female genital self-image: a psychological and sociocultural perspective

Sexual Medicine Reviews, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 20, 2025

Language: Английский

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Sexual Health Following Diagnosis and Treatment of Gynecologic Cancer

Advances in Oncology, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 1, 2025

Language: Английский

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