Unravelling one mystery for female childhood cancer survivors

New tool identifies acute ovarian failure risk for childhood cancer survivors

Cancer clinicians have a new tool that can predict how a proposed treatment for childhood cancer may influence the onset of one type of premature menopause thanks to the work of a University of Alberta master’s student.

Rebecca Clark, who recently graduated from the School of Public Health, created a free online risk calculator that allows clinicians to input the proposed treatment exposures for their patients and know how likely the treatment is going to influence the development of acute ovarian failure.

If the risk of acute ovarian failure—the development of menopause within the first five years after a cancer diagnosis—is calculated to be low, Clark says the clinician can focus on the child’s survival first, before going back to address any risk of nonsurgical premature menopause that may develop more than five years after treatment.

Clark explained that although the odds of surviving a childhood cancer diagnosis has increased significantly—from a five-year survival rate of 58 per cent in the mid-1970s to nearly 90 percent today—the research focus on survival has had unintended and long-term consequences for those who beat cancer.

“One percent of women will prematurely develop menopause before age 40, but that number jumps to 15 per cent for girls who survive childhood cancer due to their exposures to chemotherapy and radiation,” says Clark. “In addition to reproductive loss and bone loss, these girls are more likely to report feelings of anxiety, depression and insecurity.”

Clark focused her master’s thesis on the reproductive problems that females can develop, specifically, risk prediction for premature menopause. Part of the study results were published in The Lancet Oncology just after the risk calculator became available in January.

“We want to be able to provide these girls and their family a little glimpse into the future so that they can feel prepared, and also to allow for interventions,” says Clark. “If menopause is reached early, they may need hormone replacement therapy to start their period or to maintain regular body hormones.”

As it is, Clark says “more than 99 per cent of childhood cancer survivors will develop at least one type of chronic condition, from heart disease and diabetes to second cancers.”

“These girls and their families are already facing so many unknowns,” says Clark. “Helping to unravel at least one mystery and giving them a better idea of what may—or may not—happen can make a huge impact.”

 Rebecca Clark was supervised by Yan Yuan. Her Graduate Studentship project was funded by the Stollery Children’s Hospital Foundation through WCHRI.

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