Background:Endocrine therapy (ET) with or without ovarian function suppression (OFS) is a cornerstone treatment for estrogen receptor-positive (ER+) breast cancer (BC) in premenopausal women, but its impact on quality of life (QoL) and sexual health remains a concern.Methods:We conducted a multicenter, prospective, observational study including premenopausal women (≤50 years) diagnosed with stage I–III ER+ BC and treated in private healthcare facilities in Brazil between 2013 and 2023. Patients received ET alone (ET-only) or combined with OFS (OFS-ET). QoL was assessed at baseline and 3, 6, 9, 12, and 24 months using the EORTC QLQ-BR23. Sexual functioning and sexual enjoyment were prespecified primary outcomes. Logistic regression identified factors associated with OFS use, and Fisher’s exact test was applied for categorical comparisons at 24 months.Results:Among 363 patients (80% ET-only, 20% ET + OFS), younger age, advanced stage, and chemotherapy were independently associated with OFS use. Both groups reported early declines in sexual functioning and enjoyment. By 24 months, ET-only patients had returned to baseline, whereas OFS patients remained below baseline. At the item level, no significant differences were observed in sexual desire (51.5% vs. 42.0%;p= 0.33) or enjoyment (26.0% vs. 13.5%;p= 0.20). Lack of sexual activity was more frequent in the OFS group (60.6% vs. 41.2%;p= 0.05). Body image was significantly more impaired with OFS, with a higher proportion of patients reporting feeling less attractive (38.2% vs. 19.9%;p= 0.04) and less feminine (26.5% vs. 11.7%;p= 0.05).Conclusions:ET impairs sexual health in young BC survivors, particularly when combined with OFS. These findings underscore the need for routine sexual health assessments and supportive interventions in survivorship care.
背景：内分泌治疗（ET）联合或不联合卵巢功能抑制（OFS）是绝经前雌激素受体阳性（ER+）乳腺癌（BC）的基石治疗手段，但其对患者生活质量（QoL）及性健康的影响仍备受关注。 方法：我们开展了一项多中心、前瞻性、观察性研究，纳入2013年至2023年间在巴西私立医疗机构接受治疗、年龄≤50岁且诊断为I–III期ER+ BC的绝经前女性患者。患者接受单纯ET治疗（ET-only组）或ET联合OFS治疗（OFS-ET组）。在基线及治疗后3、6、9、12、24个月采用EORTC QLQ-BR23量表评估生活质量，其中性功能与性愉悦感被预设为主要观察终点。采用逻辑回归分析OFS使用的相关因素，分类变量在24个月时的比较采用Fisher精确检验。 结果：在363例患者中（80%为ET-only组，20%为ET+OFS组），年龄较轻、分期较晚及接受化疗是OFS使用的独立相关因素。两组患者均报告早期出现性功能与性愉悦感下降。至24个月时，ET-only组患者恢复至基线水平，而OFS组患者仍低于基线。在具体条目分析中，两组患者的性欲（51.5% vs. 42.0%；p=0.33）与性愉悦感（26.0% vs. 13.5%；p=0.20）无显著差异。但OFS组无性活动比例更高（60.6% vs. 41.2%；p=0.05）。OFS组患者身体意象受损更显著，更多患者报告吸引力下降（38.2% vs. 19.9%；p=0.04）及女性特质减弱（26.5% vs. 11.7%；p=0.05）。 结论：ET治疗会损害年轻乳腺癌幸存者的性健康，联合OFS时尤为明显。这些发现强调在生存期照护中需常规开展性健康评估并提供支持性干预措施。
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