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A Letter to the Editor Regarding the Article by Panjari et al.
1254
LETTERS TO THE EDITOR A Letter to the Editor Regarding the Article by Panjari et al.
jsm_2199
1254..1260
DOI: 10.1111/j.1743-6109.2010.02199.x
We read with interest “Sexual Function after Breast Cancer” [1], but wondered whether the authors considered a multivariable model including age, receipt of endocrine therapy and chemotherapy, vasomotor symptoms, and body image as independent variables, to determine their independent associations with sexual functioning problems? This model would directly compare sexual functioning problems among patients receiving tamoxifen, aromatase inhibitors (AI), and no form of endocrine therapy. Multivariable models examining independent effects of these variables on sexual functioning problems would have provided stronger support for their claims than the simple comparisons reported. Moreover, their study was limited by the lack of a comparison group of same-aged women without breast cancer. Vasomotor symptoms experienced by breast cancer patients receiving endocrine therapy may be more severe than menopausal symptoms reported by same-aged women without breast cancer. We tested this hypothesis using analysis of covariance of data from a cohort of 524 newly diagnosed early-stage breast cancer patients and a comparison (control) group of 509 same-aged women (age range 40–89) without breast cancer 1 year after definitive surgery (patients) or normal/benign screening mammogram (controls) [2]. In this analysis, not previously published, after controlling for age, in post hoc pairwise comparisons, controls reported less severe menopausal symptoms than patients taking either AI or tamoxifen (each P < 0.001) or than patients taking no hormone therapy (P = 0.001). Women taking AI reported more severe menopausal symptoms than patients taking no hormone therapy (P = 0.003), but symptom severity did not differ significantly between women taking AI and women taking tamoxifen (P = 0.096). We previously reported that more severe menopausal symptomatology was positively associated with sexual problems (problems with sexual attractiveness and sexual interest/enjoyment) in both patients and controls [2]. We further illustrate herein the value of including a comparison group of women without breast cancer. Using logistic regression models, we examined whether age, menopausal symptoms, and body image problems in controls were associated with sexual problems (“a little” and “somewhat/very much” of a problem each compared with “not a problem”) 1 year following enrollment. Controls reporting more severe menopausal symptoms (odds ratio [OR] 1.64, 95% confidence interval [95% CI] 1.18– 2.28) and body image problems (OR 2.09, 95% CI 1.55–2.82) were more likely to report “a little” problem on the sexual problems measure compared with “not a problem.” Controls reporting more severe menopausal symptoms (OR = 2.92, 95% CI = 1.77–4.81) and body image problems (OR = 2.92, 95% CI 1.83–4.65) were even more likely to report “somewhat/very much” of a problem on the sexual problems measure compared with “not a problem.” Age was not associated with sexual problem severity in either model. Thus, comparing the severity of menopausal symptoms and sexual functioning problems among breast cancer survivors who receive or do not receive endocrine therapy and a comparison group of women without breast cancer who also do not receive endocrine therapy is important. Problems with sexual functioning are not uncommon in postmenopausal women without breast cancer and it is important to emphasize that treatment for breast cancer does not necessarily result in sexual problems [2,3].
J Sex Med 2011;8:1254–1260
Acknowledgments This study was supported by a grant from the National Cancer Institute and Breast Cancer Stamp Fund (R01 CA102777) and by a National Cancer Institute Cancer Center Support Grant to the Siteman Cancer Center (P30 CA91842). We thank our patient participants, the interviewers, and the Siteman Cancer Center’s Health Behavior, Communication, and Outreach Core for data management and statistical services. We also thank the physicians who helped us recruit their patients for this study. Maria Pérez* and Donna B. Jeffe*† *School of Medicine—Department of Internal Medicine, Division of Health Behavior Research, Washington University, Saint Louis, MO, USA; †Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA Conflict of Interest: None.
Statement of Authorship
Category 1 (a) Conception and Design Donna B. Jeffe (b) Acquisition of Data Donna B. Jeffe (b) Analysis and Interpretation of Data Donna B. Jeffe; Maria Pérez
Category 2 (a) Drafting the Article Donna B. Jeffe; Maria Pérez (b) Revising It for Intellectual Content Donna B. Jeffe; Maria Pérez
Category 3 (a) Final Approval of the Completed Article Donna B. Jeffe; Maria Pérez
References 1 Panjari M, Bell RJ, Davis SR. Sexual function after breast cancer. J Sex Med 2011;8:294–302. 2 Perez M, Liu Y, Schootman M, Aft RL, Schechtman KB, Gillanders WE, Jeffe DB. Changes in sexual problems over time in women with and without early-stage breast cancer. Menopause 2010;17:924–37. 3 Kingsberg SA. Sexual problems in breast cancer survivors: Do not turn good news into no news. Menopause 2010;17:894– 5.
© 2011 International Society for Sexual Medicine
LETTERS TO THE EDITOR A Letter to the Editor Regarding the Article by Panjari et al.
jsm_2199
1254..1260
DOI: 10.1111/j.1743-6109.2010.02199.x
We read with interest “Sexual Function after Breast Cancer” [1], but wondered whether the authors considered a multivariable model including age, receipt of endocrine therapy and chemotherapy, vasomotor symptoms, and body image as independent variables, to determine their independent associations with sexual functioning problems? This model would directly compare sexual functioning problems among patients receiving tamoxifen, aromatase inhibitors (AI), and no form of endocrine therapy. Multivariable models examining independent effects of these variables on sexual functioning problems would have provided stronger support for their claims than the simple comparisons reported. Moreover, their study was limited by the lack of a comparison group of same-aged women without breast cancer. Vasomotor symptoms experienced by breast cancer patients receiving endocrine therapy may be more severe than menopausal symptoms reported by same-aged women without breast cancer. We tested this hypothesis using analysis of covariance of data from a cohort of 524 newly diagnosed early-stage breast cancer patients and a comparison (control) group of 509 same-aged women (age range 40–89) without breast cancer 1 year after definitive surgery (patients) or normal/benign screening mammogram (controls) [2]. In this analysis, not previously published, after controlling for age, in post hoc pairwise comparisons, controls reported less severe menopausal symptoms than patients taking either AI or tamoxifen (each P < 0.001) or than patients taking no hormone therapy (P = 0.001). Women taking AI reported more severe menopausal symptoms than patients taking no hormone therapy (P = 0.003), but symptom severity did not differ significantly between women taking AI and women taking tamoxifen (P = 0.096). We previously reported that more severe menopausal symptomatology was positively associated with sexual problems (problems with sexual attractiveness and sexual interest/enjoyment) in both patients and controls [2]. We further illustrate herein the value of including a comparison group of women without breast cancer. Using logistic regression models, we examined whether age, menopausal symptoms, and body image problems in controls were associated with sexual problems (“a little” and “somewhat/very much” of a problem each compared with “not a problem”) 1 year following enrollment. Controls reporting more severe menopausal symptoms (odds ratio [OR] 1.64, 95% confidence interval [95% CI] 1.18– 2.28) and body image problems (OR 2.09, 95% CI 1.55–2.82) were more likely to report “a little” problem on the sexual problems measure compared with “not a problem.” Controls reporting more severe menopausal symptoms (OR = 2.92, 95% CI = 1.77–4.81) and body image problems (OR = 2.92, 95% CI 1.83–4.65) were even more likely to report “somewhat/very much” of a problem on the sexual problems measure compared with “not a problem.” Age was not associated with sexual problem severity in either model. Thus, comparing the severity of menopausal symptoms and sexual functioning problems among breast cancer survivors who receive or do not receive endocrine therapy and a comparison group of women without breast cancer who also do not receive endocrine therapy is important. Problems with sexual functioning are not uncommon in postmenopausal women without breast cancer and it is important to emphasize that treatment for breast cancer does not necessarily result in sexual problems [2,3].
J Sex Med 2011;8:1254–1260
Acknowledgments This study was supported by a grant from the National Cancer Institute and Breast Cancer Stamp Fund (R01 CA102777) and by a National Cancer Institute Cancer Center Support Grant to the Siteman Cancer Center (P30 CA91842). We thank our patient participants, the interviewers, and the Siteman Cancer Center’s Health Behavior, Communication, and Outreach Core for data management and statistical services. We also thank the physicians who helped us recruit their patients for this study. Maria Pérez* and Donna B. Jeffe*† *School of Medicine—Department of Internal Medicine, Division of Health Behavior Research, Washington University, Saint Louis, MO, USA; †Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA Conflict of Interest: None.
Statement of Authorship
Category 1 (a) Conception and Design Donna B. Jeffe (b) Acquisition of Data Donna B. Jeffe (b) Analysis and Interpretation of Data Donna B. Jeffe; Maria Pérez
Category 2 (a) Drafting the Article Donna B. Jeffe; Maria Pérez (b) Revising It for Intellectual Content Donna B. Jeffe; Maria Pérez
Category 3 (a) Final Approval of the Completed Article Donna B. Jeffe; Maria Pérez
References 1 Panjari M, Bell RJ, Davis SR. Sexual function after breast cancer. J Sex Med 2011;8:294–302. 2 Perez M, Liu Y, Schootman M, Aft RL, Schechtman KB, Gillanders WE, Jeffe DB. Changes in sexual problems over time in women with and without early-stage breast cancer. Menopause 2010;17:924–37. 3 Kingsberg SA. Sexual problems in breast cancer survivors: Do not turn good news into no news. Menopause 2010;17:894– 5.
© 2011 International Society for Sexual Medicine