Breast cancer in premenopausal women: recurrence and survival rates and relationship to hormone replacement therapy.

OBJECTIVES: To determine any association between hormonal replacement therapy (HRT) usage and breast cancer recurrence and survival rates in women who were premenopausal at the time of diagnosis of breast cancer. METHODS: The study group comprised 524 women who were diagnosed with breast cancer when they were premenopausal. Of these, 277 women reached menopause before recurrence of the disease, being lost to follow-up, or reaching the end of the study. In this group, 119 women took HRT to control menopausal symptoms. The majority took combined continuous estrogen-progestin treatment. Times from diagnosis to cancer recurrence or new breast cancer, to death from all causes, and to death from primary tumor were compared between HRT users and non-users. RESULTS: Women who used HRT after their menopause had an adjusted relative risk of recurrence or new breast cancer of 0.75 (95% confidence interval (CI), 0.29-1.95) compared to that of non-users. The relative risk of death from all causes was 0.36 (95% CI, 0.11-1.16) and that of death from primary tumor was 0.24 (95% CI, 0.05-1.14). CONCLUSION: HRT use in women who were premenopausal at the diagnosis of primary invasive breast cancer is not associated with worse outcomes in terms of breast cancer recurrence or mortality.

Quality of life of breast cancer survivors: the impact of hormonal replacement therapy.

OBJECTIVES: The aims of this non-randomized qualitative study were to compare the quality of life (QOL) of breast cancer survivors who received hormone replacement therapy (HRT) and those who did not, and to describe the impact of breast cancer on their social, physical, psychological and spiritual domains. A QOL self-evaluation questionnaire was used to determine the most important concerns and changes described by women that affected, or were likely to affect, their QOL as a result of breast cancer. METHODS: In total, 220 patients who had finished treatment for breast cancer were contacted; 190 agreed to participate, of whom 123 (64.8%) completed and returned their questionnaires, which comprised demographic data, Quality of Life Breast Cancer Version Questionnaire and Quality of Life Self Evaluation Questionnaire. The results for women taking HRT were compared with results for those who were not. RESULTS: There were no significant differences in time between surgery for breast cancer and the survey, age at last birthday, number of pregnancies and live births, employment, breast cancer surgery and adjuvant therapy between HRT and non-HRT groups. No differences were found in the social, physical, psychological and spiritual domains between the two groups; however, significant differences were found between survival time and quality of life in some domains. During the study, none of the 123 women developed a recurrence of their breast cancer. CONCLUSION: There were no significant differences in any demographic variables between the users of HRT and the non-users. The same level of QOL was observed between HRT and non-HRT groups in the four domains of well-being. The majority of women with breast cancer recovered to a near normal level of QOL after a 4-year adjustment period, and lead fulfilling lives. This adjustment period cannot be quantified, as individual factors such as emotional, social and financial concerns will differ for each individual.

Donor insemination: attitudes of parents towards disclosure.

OBJECTIVE: To determine attitudes of parents of children conceived by donor insemination to telling the children of their origin. DESIGN: Questionnaire survey, in 1992-1993, of parents who had had a child by donor insemination at four New South Wales clinics from 1979 to 1990. SETTING: Three hospital-based clinics (two public, one private) and a private clinic service. PARTICIPANTS: 276 families who altogether had had 420 children by donor insemination. MAIN OUTCOME MEASURES: Number of children told that they had been conceived by donor insemination; parents' intentions, before conceiving and after the birth, of informing the child; and whether other people were informed of the child's origin. RESULTS: Of 393 families who could be contacted, 353 agreed to participate and 276 (70%) replied to the questionnaire. Only 22 of the 420 children (5.2%) had been informed of their origin. Before conceiving, 18% of parents (49/273) planned to tell the child. Seventy-one per cent of families (182/257) had told others of the origin of the child, but 94% (241/257) had not told the child. Of the 29% of families (75/257) who had not told others of the child's origins, none had told the child. As the children grow older, more parents decide not to tell them of their origin. CONCLUSIONS: Most parents of children conceived by donor insemination do not plan to tell their child, but most of these parents have told others, creating the potential for accidental disclosure. Because of the small number of children who are told of their origin, there may not be a need for government-regulated donor registers, provided donor insemination units maintain a high standard of record-keeping.

Donor insemination: effects on parents.

OBJECTIVE: To examine the psychosocial effects of donor insemination on couples. DESIGN: Questionnaire survey of couples who had a child by donor insemination at four NSW clinics over a 15-year period. RESULTS: Forty-seven per cent of couples thought their marriage had improved, while 3% thought their marriage had deteriorated as a result of having a child by donor insemination. Seventy-six per cent felt it had a positive personal effect and almost all couples had no regrets about having a child this way. Over 90% of respondents felt very close to these children. In those who also had children not conceived by donor insemination (60 couples), men were significantly closer to their children by donor insemination than to their "other" children (P < 0.001). There was a significant sex difference in perceptions of the child's resemblance (P < 0.0001): 61% of women thought their child conceived by donor insemination resembled their partner, while 89% of men thought the child resembled their partner. Twenty-one per cent of couples were concerned about having to tell the child about donor insemination. CONCLUSION: Donor insemination can have positive psychosocial effects on couples and close relationships exist between the parents and their children conceived by donor insemination. The concern about the physical appearance of children conceived by donor insemination can be allayed by our finding that the majority of couples see a resemblance between the child and their partner.