A Population-Based Study of Fertility in Female Survivors of Young Adult Cancer

描述(由申请人提供)：2007年由尤尼斯·肯尼迪·施莱弗国家儿童健康和人类发展研究所召集的一个专家小组强调，需要在癌症幸存者的生育领域进行更多的研究。随着存活率的提高，越来越明显的是，许多挽救生命的癌症疗法损害了儿童癌症幸存者的生育能力。青壮年癌症的幸存者也会受到影响，但这一人群中不孕不育的发病率和流行率尚不清楚。我们建议进行一项基于人群的流行病学研究，以确定年轻成人癌症(确诊年龄在20-39岁之间的癌症)女性幸存者因暴露于化疗和放射治疗而继发性腺损伤的风险。合格的癌症幸存者将通过屡获殊荣的佐治亚州癌症统计中心来确定，该中心运营着全州范围内的佐治亚州综合癌症登记中心和国家癌症研究所SEER计划的大都会亚特兰大监测流行病学和最终结果登记中心。居住在亚特兰大市的年轻成年癌症的育龄女性幸存者将有资格，她们接受不同癌症治疗的机会将基于医疗记录的摘要而确定。我们还将招募一个以社区为基础的对照组，对没有接受癌症治疗的女性进行比较。评估不孕不育的发病率和患病率是具有挑战性的，因为没有任何单一的结果衡量标准能够真正反映生育能力受损的情况，而且在尝试怀孕之前，不孕不育通常是无法识别的。因此，我们将从两个目标概括的几个角度来评估生育力。首先，我们将评估癌症幸存者(n=2,000)与未接触过癌症的女性(n=1,000)的生育史。我们将使用深入的计算机辅助电话采访(CATI)来收集与生殖潜力有关的广泛因素的数据，包括月经史、孕产史、不孕史和对孩子的渴望。其次，我们将评估癌症幸存者(n=750)与未暴露的女性(n=250)目前的生育力，基于一些临床指标，包括抗M|llerian激素水平、腔卵泡计数、卵巢体积和子宫体积。我们的建议在几个方面是创新的。它改进了现有的研究，首先是以年轻的成年癌症幸存者为人口基础，其次是通过评估每名妇女生殖寿命的各种生育指标，并将这一信息与人口中一大部分当前生育能力的生物标志物的测量相结合，充分捕捉生育力的复杂性质。对于被诊断患有癌症的年轻女性来说，不同疗法对她们生育能力的潜在影响往往是一个重要的担忧，但目前，临床医生提供建议的信息有限。我们的建议将直接解决这一关键的知识差距。

DESCRIPTION (provided by applicant): A 2007 expert panel convened by the Eunice Kennedy Shriver National Institute of Child Health and Human Development highlighted the need for more research in the area of fertility among cancer survivors. As survival rates have improved, it has become increasingly apparent that many life-saving cancer therapies impair fertility among childhood cancer survivors. Survivors of young adult cancers are affected as well, but the incidence and prevalence of infertility in this population is unknown. We propose to perform a population-based epidemiology study to characterize the risks of gonadal damage secondary to exposure to chemotherapy and radiation therapy in female survivors of young adult cancers (cancers diagnosed between the ages of 20-39). Eligible cancer survivors will be identified through the award-winning Georgia Center for Cancer Statistics, which operates both the statewide Georgia Comprehensive Cancer Registry and the Metropolitan Atlanta Surveillance Epidemiology and End Results (SEER) Registry of the National Cancer Institute's SEER Program. Reproductive age female survivors of young adult cancers living in Metropolitan Atlanta will be eligible, and their exposure to different cancer treatments will be determined based on abstraction of medical records. We will also recruit a community-based comparison group of women who were not exposed to cancer therapies. Evaluating the incidence and prevalence of infertility is challenging because no single outcome measure truly captures compromised fertility, and subfertility is usually unrecognized until pregnancy is attempted. Therefore, we will evaluate fertility from several angles summarized by two aims. First, we will assess the fertility history of cancer survivors (n=2,000) compared to unexposed women (n=1,000). We will use an in-depth computer assisted telephone interview (CATI) to collect data on a wide range of factors contributing to reproductive potential including, menstrual history, pregnancy history, infertility history, and desire for children. Second, we will assess current fertility of cancer survivors (n=750) compared to unexposed women (n=250) based on a number of clinical markers including anti-M|llerian hormone levels, antral follicle count, ovarian volume, and uterine volume. Our proposal is innovative in several areas. It improves upon existing studies first by being population based in young adult cancer survivors and second by fully capturing the complex nature of fertility by assessing a wide range of indicators of fertility across each woman's reproductive life span and combining this information with measurement of biomarkers of current fertility in a large subset of the population. For young women diagnosed with cancer, the potential effect of different therapies on their ability to have children is often a significant concern, but at present, clinicians have limited information with which to advise them. Our proposal will directly address this critical gap in knowledge.