2 days ago
Colorectal Cancer Linked With Adverse Sexual Health Outcomes
As new colorectal cancer (CRC) cases and related mortality continued to decline among Canadians older than 50 years, a new finding emerged: An increased risk for sexual health conditions in women with CRC, especially those with early-onset CRC (diagnosed in women younger than 50 years). These patients have as much as a 90% higher risk for dyspareunia compared with cancer-free peers.
Other striking findings of the recently published study included elevated risks for premature ovarian failure, pelvic inflammatory disease (PID), and endometriosis among women with CRC.
Study co-author Mary De Vera, PhD, a pharmacoepidemiologist and assistant professor of pharmaceutical sciences at the University of British Columbia (BC) in Vancouver, was diagnosed with early-onset CRC at age 36 years. 'The motivation for me to look at sexual and reproductive health outcomes stemmed from my own lived experience,' she told Medscape Medical News.
Mary De Vera, PhD
The study was published online on June 1 in the Journal of the National Cancer Institute .
Sexual Health Challenges
The researchers conducted a population-based cohort study to evaluate the impact of CRC on the following six outcomes: Dyspareunia, abnormal bleeding outside pregnancy, PID, endometriosis, premature ovarian failure (ie, early menopause in women younger than 40 years), and at least one hormone replacement therapy prescription.
Eligible participants were identified in BC administrative health data (which contains linked healthcare visits and the BC Cancer Registry) and included patients assigned female at birth who were diagnosed with CRC between January 1, 1985, and December 31, 2017 (n = 25,402). These participants were matched by age and sex 1:10 to cancer-free controls (n = 254,020). The participants were further stratified by age (≤ 39 years, ≥ 40 years), and sensitivity analyses were conducted to explore the association between sociodemographic and cancer-related factors (eg, cancer site or treatment type) on sexual health outcomes.
The most common cancer sites were the left colon (39.8%) and rectum (28.8%), and the most frequent treatments were surgery (42.9%) and chemotherapy (35.5%). Overall, participants with CRC had more healthcare encounters in the previous year than matched control individuals did (15.1 vs 10.9; P < .0001).
Women with CRC had a 67% higher risk for dyspareunia compared with women without cancer. 'When we further stratified them by age, the risk actually rose to 90% in females diagnosed before age 40,' said De Vera.
Treatment-related effects were common. Sensitivity analysis demonstrated an increased dyspareunia risk with surgery (hazard ratio [HR], 1.23), chemotherapy (HR, 1.25), and radiation (HR, 1.24). Women receiving chemotherapy had an increased risk for abnormal bleeding (HR, 1.24).
CRC was associated with increased PID risk (HR, 3.42). Cancer site and treatment were independently associated with increased risk. For example, the risk for PID increased by 80% in participants diagnosed with CRC in the left colon and by 121% for rectal CRC. Radiation treatment was associated with a 56% increased risk.
Additional notable findings included a 95% higher risk for endometriosis across all ages, with an 80% increase noted in women who had received surgery. Risk for premature ovarian failure appeared to increase more significantly in younger women with CRC than in those without (HR, 1.75). Chemotherapy was associated with a 164% higher risk.
Causation Unclear
De Vera pointed to a surprising but important finding related to the timing of diagnosis. 'We were finding that a lot of sexual health issues were diagnosed in the 3-4 years after the original cancer diagnosis, which showed me that a lot of these issues were surfacing during the survivorship stage,' she said.
However, the study is not without limitations. Though findings suggested that there is an effect of cancer itself and that many of the conditions were being driven by cancer treatments, these effects have not been clearly delineated or defined.
De Vera also said that the increase in health encounters amongst women with CRC suggested that certain drivers (eg, pain during or after sex) might not have been captured in the medical records.
Jaclyn Madar, MD, assistant professor of obstetrics and gynecology at McGill University and clinician at Sir Mortimer B. Davis Jewish General Hospital in Montreal, told Medscape Medical News that although pain disorders like endometriosis or dyspareunia can affect pleasure during intercourse, it's important to note that not all patients face the same situation.
Jaclyn Madar, MD
'When you have a woman with sexual pain, you really have to look into what the cause of it might be, regardless of age,' said Madar, who was not involved in the study.
'What's front of mind for a lot of these women is to treat the cancer, and then afterward deal with the aftermath,' she said. 'It doesn't seem to me that it is integrated into the care, and I believe that it's important to warn that when they go through certain types of chemo, for example, they'll probably enter early menopause or have menopause symptoms.'
Madar noted that the prevalence of many of these conditions is difficult to estimate, namely because patients don't always volunteer the information, and diagnosis is often delayed. For CRC in particular, radiation can have significant effects on vaginal tissues and cause vaginal stenosis, while surgical treatments have a domino effect: Post-op pain near the rectum can lead to pelvic floor muscle spasms and subsequent dyspareunia.
'The findings will lead to greater awareness and better communication,' said De Vera hopefully.
The study was funded by grants from the Canadian Institutes of Health Research. De Vera and Madar reported having no relevant financial relationships.
