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·施莱佛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治疗损害了儿童癌症幸存者的生育能力。年轻成人癌症的幸存者也受到影响，但这一人群中不孕症的发病率和患病率尚不清楚。我们建议进行一项基于人群的流行病学研究，以确定年轻成年癌症（20-39岁之间诊断的癌症）的女性幸存者接受化疗和放疗后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癌症统计中心确定，该中心运营全州范围的佐治亚综合癌症登记处和国家癌症研究所SEER计划的亚特兰大大都会监测流行病学和最终结果登记处。居住在亚特兰大大都市的年轻成年癌症的育龄女性幸存者将符合条件，她们接受不同癌症治疗的程度将根据医疗记录的抽象化来确定。我们还将招募一个以社区为基础的比较组，这些妇女没有接受过癌症治疗。评估不孕症的发病率和流行程度是具有挑战性的，因为没有单一的结果测量方法真正捕捉到生育力受损，而生育力低下通常在尝试怀孕之前是无法识别的。因此，我们将根据两个目的从几个角度来评价生育能力。首先，我们将评估癌症幸存者（n= 2000）与未暴露妇女（n= 1000）的生育史。我们将使用深入的计算机辅助电话访谈（CATI）来收集影响生殖潜力的各种因素的数据，包括月经史、怀孕史、不孕症史和对孩子的渴望。其次，我们将评估癌症幸存者（n=750）与未暴露妇女（n=250）的当前生育能力，基于一些临床指标，包括抗m - |红叶杆菌激素水平、窦卵泡计数、卵巢体积和子宫体积。我们的建议在几个方面具有创新性。它在现有研究的基础上进行了改进，首先是基于年轻成年癌症幸存者的人口，其次是通过评估每个女性生殖寿命的广泛生育指标，并将这些信息与大量人口中当前生育能力的生物标志物测量相结合，全面捕捉生育能力的复杂性。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大问题，但目前，临床医生提供的建议有限。我们的建议将直接解决这一关键的知识缺口。

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.