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      Sexual dysfunction and reproductive concerns in young women with breast cancer: Type, prevalence, and predictors of problems

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          Abstract

          Objective

          A dearth of studies focusing on young women (<40 years) with breast cancer have hampered the understanding of the type, prevalence, and predictors of sexual dysfunction and reproductive concerns in this population.

          Methods

          Data were collected from 181 women (response rate = 60%) diagnosed with breast cancer approximately 2 years previously (age 21‐39) using the Swedish National Quality Registry for Breast Cancer and a survey including standardized measures of sexual dysfunction, reproductive concerns, body image, and health‐related quality of life. Multivariable logistic binary regression analyses were used to identify predictors of sexual dysfunction and reproductive concerns.

          Results

          Sexual dysfunction in at least one domain was reported by 68% of the women, and a high level of reproductive concerns in at least one dimension was reported by 58%. Model results showed that current endocrine treatment was a significant predictor of dysfunction related to lubrication (OR 3.8, 95% CI 1.2‐12.1) and vaginal discomfort (OR 8.7, 95% CI 1.5‐51.5). Negative body image was related to satisfaction with sex life (OR 1.1, 95% CI 1.0‐1.2). A high level of reproductive concerns was predicted by a wish for (additional) children in the future (OR 3.4, 95% CI 1.1‐10.2) and by previous chemotherapy (OR 2.5, 95% CI 1.1‐5.9).

          Conclusions

          Sexual dysfunction and reproductive concerns are common in young women with breast cancer. Current endocrine treatment, previous chemotherapy, a negative body image, and a wish for children in the future predict higher level of problems.

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          Most cited references30

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          Body image and sexual problems in young women with breast cancer.

          The purpose of this study was to determine the frequency of body image and sexual problems in the first months after treatment among women diagnosed with breast cancer at age 50 or younger. Breast cancer treatment may have severe effects on the bodies of younger women. Surgical treatment may be disfiguring, chemotherapy may cause abrupt menopause, and hormone replacement is not recommended. A multi-ethnic population-based sample of 549 women aged 22-50 who were married or in a stable unmarried relationship were interviewed within seven months of diagnosis with in situ, local, or regional breast cancer. Body image and sexual problems were experienced by a substantial proportion of women in the early months after diagnosis. Half of the 546 women experienced two or more body image problems some of the time (33%), or at least one problem much of the time (17%). Among sexually active women, greater body image problems were associated with mastectomy and possible reconstruction, hair loss from chemotherapy, concern with weight gain or loss, poorer mental health, lower self-esteem, and partner's difficulty understanding one's feelings. Among the 360 sexually active women, half (52%) reported having a little problem in two or more areas of sexual functioning (24%), or a definite or serious problem in at least one area (28%). Greater sexual problems were associated with vaginal dryness, poorer mental health, being married, partner's difficulty understanding one's feelings, and more body image problems, and there were significant ethnic differences in reported severity. Difficulties related to sexuality and sexual functioning were common and occurred soon after surgical and adjuvant treatment. Addressing these problems is essential to improve the quality of life of young women with breast cancer.
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            Review of 103 Swedish Healthcare Quality Registries.

            In the past two decades, an increasing number of nationwide, Swedish Healthcare Quality Registries (QRs) focusing on specific disorders have been initiated, mostly by physicians. Here, we describe the purpose, organization, variables, coverage and completeness of 103 Swedish QRs.
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              The effects of radiotherapy and chemotherapy on female reproduction.

              High dose chemotherapy and radiotherapy have radically increased long-term survival of young cancer patients, but major side effects of these treatments are ovarian failure and infertility. Knowledge of the risks and probabilities of ovarian failure caused by treatment is crucial for patients and physicians in order to make informed choices that will best serve patients' interests. This review presents data on ovarian damage and failure following exposure to radiotherapy, chemotherapy and ablative therapy. The risk is evaluated from the published literature according to patient's age, treatment protocol and also according to the diagnosis of some common malignancies. Many of these patients will not be sterilized immediately following treatment, but will suffer from premature menopause. In order to prevent sterilization, ovarian transposition before pelvic irradiation is mandatory. Besides cryopreservation of ovarian tissue and embryos before administration of chemotherapy, the possible protective effect of pituitary-ovarian down-regulation is discussed. The mechanism of primordial follicles damage induced by radio/chemotherapy is presented as well as the role of apoptosis signalling pathways underlying destruction. Increased knowledge of these mechanisms could help to identify potential effective inhibitors that can block the path of primordial follicles destruction and reduce ovarian failure rate.
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                Author and article information

                Contributors
                lisa.ljungman@ki.se
                Journal
                Psychooncology
                Psychooncology
                10.1002/(ISSN)1099-1611
                PON
                Psycho-Oncology
                John Wiley and Sons Inc. (Hoboken )
                1057-9249
                1099-1611
                27 September 2018
                December 2018
                : 27
                : 12 ( doiID: 10.1002/pon.v27.12 )
                : 2770-2777
                Affiliations
                [ 1 ] Department of Women's and Children's Health Karolinska Institutet Solna Sweden
                [ 2 ] Department of Oncology, Faculty of Medicine and Health Örebro University Örebro Sweden
                [ 3 ] Regional Cancer Centre, Uppsala‐Örebro Uppsala Sweden
                [ 4 ] Department of Neurobiology, Care Sciences and Society Karolinska Institutet Solna Sweden
                [ 5 ] Department of Medicine Medical College of Wisconsin Milwaukee WI USA
                [ 6 ] Department of Population Health Sciences Duke University School of Medicine Durham NC USA
                [ 7 ] College of Public Health and Human Sciences Oregon State University Corvallis OR USA
                Author notes
                [*] [* ] Correspondence

                Lisa Ljungman, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Solna, Sweden.

                Email: lisa.ljungman@ 123456ki.se

                Lena Wettergren and Claudia Lampic Joint senior authorship

                Author information
                http://orcid.org/0000-0003-1406-6329
                http://orcid.org/0000-0002-3950-4260
                http://orcid.org/0000-0003-1279-2191
                http://orcid.org/0000-0002-1739-4486
                Article
                PON4886 PON-18-0348.R1
                10.1002/pon.4886
                6585728
                30203884
                de40fb7e-e184-4f70-bd97-e09a0bbaa1fe
                © 2018 The Authors. Psycho‐Oncology Published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 21 May 2018
                : 16 August 2018
                : 06 September 2018
                Page count
                Figures: 0, Tables: 4, Pages: 8, Words: 3241
                Funding
                Funded by: Doctoral School in Health Care Sciences at Karolinska Institutet
                Funded by: Swedish Research Council for Health, Working Life and Welfare
                Award ID: 2014‐4689
                Funded by: Vårdal Foundation
                Award ID: 2014‐0098
                Funded by: Swedish Childhood Cancer Foundation
                Award ID: TJ2014‐0050
                Funded by: Swedish Cancer Society
                Award ID: CAN 2013/886
                Funded by: Cancer Research Foundations of Radiumhemmet
                Award ID: 161272
                Categories
                Paper
                Papers
                Custom metadata
                2.0
                pon4886
                December 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.4 mode:remove_FC converted:20.06.2019

                body image,breast cancer,cancer,oncology,quality of life,reproductive concerns,sexual function,young

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