Cancer Causes & Control

, Volume 27, Issue 11, pp 1325–1332 | Cite as

Endocrine therapy and urogenital outcomes among women with a breast cancer diagnosis

  • Suzanne N. Landi
  • Kemi M. Doll
  • Jeannette T. Bensen
  • Laura Hendrix
  • Carey K. Anders
  • Jennifer M. Wu
  • Hazel B. Nichols
Original Paper



Endocrine therapy for breast cancer can exacerbate menopausal symptoms. The association between endocrine therapy and common pelvic floor disorders including urinary incontinence has rarely been evaluated. We examined urogenital and sexual side effects among women with a breast cancer diagnosis, comparing endocrine therapy users to nonusers.


Urogenital and sexual symptoms were self-reported during the enrollment interview within the University of North Carolina Cancer Survivorship Cohort. Tumor characteristics and endocrine therapy use were collected from medical and prescription records. We calculated multivariable prevalence ratios (PR) and 95 % confidence intervals (CI) for the association of endocrine therapy (versus no endocrine therapy) and urinary incontinence, overall and by therapy type (tamoxifen or aromatase inhibitors). PROMIS Sexual Function and Satisfaction domain scores were compared across endocrine therapy groups.


Among the 548 women with a breast cancer diagnosis, 49 % received endocrine therapy. Overall, 18 % of women reported urinary incontinence symptoms. We observed no association between urinary incontinence and endocrine therapy use overall (PR = 0.97; 95 % CI 0.67, 1.43), tamoxifen (PR = 1.20; 95 % CI 0.74, 1.96), or aromatase inhibitors (PR = 0.89; 95 % CI 0.55, 1.42), compared to no use. Approximately 55 % of women were sexually active. Sexual function scores did not vary according to endocrine therapy use, although urinary incontinence was associated with lower satisfaction scores (p = 0.05).


Our findings demonstrate a high prevalence of urinary incontinence after breast cancer diagnosis similar to the overall prevalence in older U.S. women, and this did not vary strongly according to use of endocrine therapy.


Endocrine therapy Cancer survivors Patient-reported outcomes Urinary incontinence Sexual function 



The authors thank the UNC Health Registry/Cancer Survivorship Cohort (HR/CSC) participants for their important contributions and appreciate the helpful comments of Dr. Antonia Bennett. The UNC HR/CSC is funded in part by the UNC Lineberger Comprehensive Cancer Center’s University Cancer Research Fund.

Compliance with ethical standards


This research was supported in part by the National Center for Advancing Translational Sciences (KL2-TR001109).

Conflict of interest

Dr. Jennifer Wu has received institutional research grants from Boston Scientific and Pelvalon. The remaining authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    American Cancer Society (2015) Cancer facts & figures 2015. American Cancer Society, AtlantaGoogle Scholar
  2. 2.
    Howlader N, Noone AM, Krapcho M et al (2015) SEER cancer statistics review, 1975–2012. National Cancer Institute, BethesdaGoogle Scholar
  3. 3.
    American Cancer Society (2015) Breast cancer facts & figures 2015–2016. American Cancer Society, Inc., AtlantaGoogle Scholar
  4. 4.
    Burstein HJ, Temin S, Anderson H et al (2014) Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: American Society of Clinical Oncology clinical practice guideline focused update. J Clin Oncol 32(21):2255–2269. doi: 10.1200/jco.2013.54.2258 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Chin SN, Trinkaus M, Simmons C et al (2009) Prevalence and severity of urogenital symptoms in postmenopausal women receiving endocrine therapy for breast cancer. Clin Breast Cancer 9(2):108–117. doi: 10.3816/CBC.2009.n.020 CrossRefPubMedGoogle Scholar
  6. 6.
    Cella D, Fallowfield L, Barker P et al (2006) Quality of life of postmenopausal women in the ATAC (“Arimidex”, tamoxifen, alone or in combination) trial after completion of 5 years’ adjuvant treatment for early breast cancer. Breast Cancer Res Treat 100(3):273–284. doi: 10.1007/s10549-006-9260-6 CrossRefPubMedGoogle Scholar
  7. 7.
    Fallowfield LJ, Bliss JM, Porter LS et al (2006) Quality of life in the intergroup exemestane study: a randomized trial of exemestane versus continued tamoxifen after 2 to 3 years of tamoxifen in postmenopausal women with primary breast cancer. J Clin Oncol 24(6):910–917. doi: 10.1200/jco.2005.03.3654 CrossRefPubMedGoogle Scholar
  8. 8.
    Morales L, Neven P, Timmerman D et al (2004) Acute effects of tamoxifen and third-generation aromatase inhibitors on menopausal symptoms of breast cancer patients. Anticancer Drugs 15(8):753–760CrossRefPubMedGoogle Scholar
  9. 9.
    Nygaard I, Barber MD, Burgio KL et al (2008) Prevalence of symptomatic pelvic floor disorders in US women. JAMA 300(11):1311–1316. doi: 10.1001/jama.300.11.1311 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Wu JM, Matthews CA, Vaughan CP et al (2015) Urinary, fecal, and dual incontinence in older U.S. adults. J Am Geriatr Soc 63(5):947–953. doi: 10.1111/jgs.13385 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    White AJ, Reeve BB, Chen RC et al (2013) Urinary incontinence and health-related quality of life among older Americans with and without cancer: a cross-sectional study. BMC Cancer 13:377. doi: 10.1186/1471-2407-13-377 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Albertazzi P, Sharma S (2005) Urogenital effects of selective estrogen receptor modulators: a systematic review. Climacteric 8(3):214–220. doi: 10.1080/13697130500117946 CrossRefPubMedGoogle Scholar
  13. 13.
    Hendrix SL, Cochrane BB, Nygaard IE et al (2005) Effects of estrogen with and without progestin on urinary incontinence. JAMA 293(8):935–948. doi: 10.1001/jama.293.8.935 CrossRefPubMedGoogle Scholar
  14. 14.
    Sharma S, Albertazzi P, Bottazzi M (2007) The long-term effect of raloxifene on the genitourinary tract. Climacteric 10(3):244–248. doi: 10.1080/13697130701379311 CrossRefPubMedGoogle Scholar
  15. 15.
    Zbucka-Kretowska M, Marcus-Braun N, Eboue C et al (2011) Expression of estrogen receptors in the pelvic floor of pre- and post-menopausal women presenting pelvic organ prolapse. Folia Histochem Cytobiol 49(3):521–527CrossRefPubMedGoogle Scholar
  16. 16.
    Flynn KE, Lin L, Cyranowski JM et al (2013) Development of the NIH PROMIS (R) sexual function and satisfaction measures in patients with cancer. J Sex Med 10(Suppl 1):43–52. doi: 10.1111/j.1743-6109.2012.02995.x CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    PROMIS Sexual Function Domain Group (2015) PROMIS Sexual Function and Satisfaction Measures User Manual. PROMIS Network, Chapel Hill, NC. Accessed 20 Dec 2015
  18. 18.
    Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 41(5):582–592. doi: 10.1097/01.mlr.0000062554.74615.4c PubMedGoogle Scholar
  19. 19.
    Baumgart J, Nilsson K, Stavreus-Evers A et al (2011) Urogenital disorders in women with adjuvant endocrine therapy after early breast cancer. Am J Obstet Gynecol 204(1):26 e1–26 e7. doi: 10.1016/j.ajog.2010.08.035 CrossRefGoogle Scholar
  20. 20.
    Cody JD, Jacobs ML, Richardson K et al (2012) Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev 10:CD001405. doi: 10.1002/14651858.CD001405.pub3 PubMedGoogle Scholar
  21. 21.
    Agency for Healthcare Research and Quality (2012) Nonsurgical treatments for urinary incontinence in adult women: diagnosis and comparative effectiveness. Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD, Contract No.: Pub. No. 11(12)-EHC074-1Google Scholar
  22. 22.
    Buzdar A, Howell A, Cuzick J et al (2006) Comprehensive side-effect profile of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: long-term safety analysis of the ATAC trial. Lancet Oncol 7(8):633–643. doi: 10.1016/s1470-2045(06)70767-7 CrossRefPubMedGoogle Scholar
  23. 23.
    Frechette D, Paquet L, Verma S et al (2013) The impact of endocrine therapy on sexual dysfunction in postmenopausal women with early stage breast cancer: encouraging results from a prospective study. Breast Cancer Res Treat 141(1):111–117. doi: 10.1007/s10549-013-2659-y CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Suzanne N. Landi
    • 1
  • Kemi M. Doll
    • 2
    • 3
  • Jeannette T. Bensen
    • 1
    • 3
  • Laura Hendrix
    • 3
  • Carey K. Anders
    • 3
  • Jennifer M. Wu
    • 4
  • Hazel B. Nichols
    • 1
  1. 1.Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Lineberger Comprehensive Cancer Center, School of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA
  4. 4.Department of Obstetrics and Gynecology, School of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA

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