Pubertal development

Are children who receive cancer treatment at increased risk of pubertal arrest or delay after treatment?

Surprisingly few studies have investigated the impact that cancer treatment may have on the pubertal development of people with a history of cancer during childhood, considering the potential impact of cancer treatment on fertility. Most are from the Childhood Cancer Survivor Study (CCSS), a retrospective cohort study of children and adolescents treated for childhood cancer at 26 collaborating institutions in the United States and Canada. Prospective studies are needed to enhance the data discussed in this section.

Delayed puberty

Data from the CCSS identified children with a history of brain tumors and rhabdomyosarcoma to be at increased risk of late-onset hypothyroidism, growth hormone deficiency and the need for medications to induce puberty^.[1][2] Delayed puberty and growth hormone deficiency was also more likely in a smaller cohort of Japanese children with a history of cancer.^[3]

Timing of menarche

Data from the CCSS of children with a history of acute lymphoblastic leukaemia (ALL), confirm results from an earlier, smaller study^[4] that identified the timing of menarche for girls to be in the normal range.^[5] These studies suggest that abnormal timing of menarche is more likely to occur in ALL patients who receive cranial or craniospinal radiotherapy.^[4][5] A separate study from the CCSS identified children with a history of central nervous system tumours may be more likely to have early onset of menarche.^[6]