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Androgens and musculoskeletal symptoms among breast cancer patients on aromatase inhibitor therapy

  • Epidemiology
  • Published:
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Abstract

Aromatase inhibitors (AIs), the adjuvant hormonal treatment of choice for postmenopausal estrogen receptor-positive breast cancer, are associated with an increased risk of musculoskeletal symptoms. The underlying cause of the symptoms is often attributed to estrogen depletion, yet all women treated with AIs have low estrogen levels and only a subset develop symptoms. Concentrations of circulating androgens may be mediating factors contributing to these side effects. The purpose of this study was to examine changes in androgen concentrations among women initiating AI therapy and to determine if concentrations are associated with musculoskeletal symptoms. Data were analyzed from a cohort study of 74 breast cancer patients for whom AI therapy was planned. Questionnaire data on symptoms were collected and blood was drawn prior to AI therapy (baseline) and then again at 3 and 6 months after baseline. Blood was assayed for testosterone, androstenedione, dehydroepiandrosterone-sulfate (DHEAS), and sex hormone-binding globulin (SHBG). Free testosterone index (FTI) values were calculated using testosterone and SHBG measurements. The results showed that concentrations of all of the androgens increased over the study period, with statistically significant differences from baseline concentrations observed for the FTI at 3 and 6 months and for DHEAS at 6 months. Additionally, breast cancer patients with new onset or worsening of pain over the study period had a significantly smaller change in mean DHEAS concentration from baseline to 3 months (P = 0.04) and a marginally significant smaller change in mean DHEAS concentration from baseline to 6 months (P = 0.1) compared to those who reported no pain at all time points or no worsening of pain across the study period. Changes in testosterone, androstenedione, and the FTI were not associated with the onset or worsening of pain during the study period. Findings from this study suggest that higher DHEAS concentrations are associated with less AI-associated pain and should be further investigated.

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Acknowledgments

The work was supported by grants from the National Cancer Institute (R03 CA132147), AstraZeneca (IRUSANAS0073) and the Susan G. Komen for the Cure Foundation (POP0601174).

Conflict of interest

The authors declare no conflicts of interest and have full control of the primary data for which results are reported in this manuscript.

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Authors and Affiliations

  1. The Prevention and Research Center, The Weinberg Center for Women’s Health & Medicine, Mercy Medical Center, 227 St. Paul Place, 6th Floor, Baltimore, MD, 21202, USA

    Lisa Gallicchio, Ryan MacDonald, Bethany Wood & Kathy J. Helzlsouer

  2. The Center for Endocrinology, The Weinberg Center for Women’s Health & Medicine, Mercy Medical Center, Baltimore, MD, USA

    Errol Rushovich

Authors
  1. Lisa Gallicchio
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  2. Ryan MacDonald
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  3. Bethany Wood
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  4. Errol Rushovich
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  5. Kathy J. Helzlsouer
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Correspondence to Lisa Gallicchio.

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Gallicchio, L., MacDonald, R., Wood, B. et al. Androgens and musculoskeletal symptoms among breast cancer patients on aromatase inhibitor therapy. Breast Cancer Res Treat 130, 569–577 (2011). https://doi.org/10.1007/s10549-011-1611-2

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  • DOI: https://doi.org/10.1007/s10549-011-1611-2

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