The research, conducted by a team at the University of Health Sciences Prof. Dr. Cemil Tascioglu City Hospital and published in BMC Cancer, examined 138 premenopausal women with non-metastatic, hormone receptor-positive, HER2-positive breast cancer. All of the patients had undergone neoadjuvant therapy — treatment given before surgery — built around anti-HER2 agents, followed by surgical removal of their tumors between 2015 and 2024. The investigators then split the cohort according to whether the women received ovarian function suppression, or OFS, during the adjuvant period, the phase of care that follows surgery and is designed to mop up any remaining cancer cells.

The biology behind the question is straightforward. In premenopausal women, the ovaries are the dominant source of estrogen, the hormone that fuels the growth of hormone receptor-positive tumors. Blocking ovarian output — typically with gonadotropin-releasing hormone agonists that effectively switch the ovaries off — dramatically lowers circulating estrogen. Combined with drugs such as tamoxifen, which blocks estrogen receptors on cancer cells, or aromatase inhibitors, which block estrogen synthesis in peripheral tissues, ovarian suppression is intended to starve any residual disease of its principal growth signal. In HER2-negative disease, landmark trials have shown clear benefits from this strategy. But HER2-positive tumors behave differently, and the arrival of potent anti-HER2 therapies such as trastuzumab has transformed outcomes, raising the possibility that the incremental value of ovarian suppression has shrunk.

That possibility is precisely what the Turkish team set out to test. Of the 138 patients, 60 — or 43.5 percent — received ovarian function suppression as part of their adjuvant endocrine treatment. The remaining 78 did not. The researchers tracked three primary endpoints: disease-free survival, which measures the time before cancer returns anywhere in the body; distant disease-free survival, which focuses specifically on spread to distant organs; and overall survival. They also assessed pathological complete response, abbreviated pCR, as a secondary endpoint. A pCR means that when pathologists examine the tissue removed at surgery, they find no invasive cancer in the breast and no cancer in the sampled lymph nodes — a marker widely regarded as one of the strongest predictors of long-term cure.

The headline numbers were striking in places. Overall, 42 percent of the entire cohort achieved a pathological complete response, a figure that underscores just how powerful neoadjuvant anti-HER2 therapy has become. After a median follow-up of 56 months, 20 patients — 14.5 percent — had experienced a recurrence or developed metastatic disease, and 11 patients, or 8 percent, had died. Those figures, sobering as they are, reflect the reality of a disease subtype that remains challenging even in the modern therapeutic era.

When the investigators compared the two groups, the differences were modest at best. Five-year overall survival was 93.9 percent among women who received ovarian suppression versus 85.8 percent among those who did not — a numerical gap, but one that did not reach statistical significance, with a p-value of 0.4. Disease-free survival was essentially identical between the arms: 80.7 percent with ovarian suppression and 81.3 percent without, yielding a p-value of 0.9. Distant disease-free survival followed the same pattern. In other words, on the primary measures of whether cancer came back or whether patients lived, the addition of ovarian suppression made no statistically detectable difference in this cohort.

The most intriguing signal emerged when the researchers stratified patients by their response to neoadjuvant therapy. Women who achieved a pathological complete response had excellent outcomes regardless of whether their ovaries were subsequently suppressed — their five-year overall survival was a remarkable 100 percent. This finding reinforces a growing consensus in oncology: for patients whose tumors vanish under preoperative anti-HER2 treatment, the prognosis is already so favorable that additional endocrine intensification may contribute little. The residual-disease group told a more nuanced story. Among women who still had detectable cancer at surgery, ovarian suppression was associated with numerically higher overall survival — 89.9 percent versus 77.6 percent — but this apparent advantage did not translate into a disease-free survival benefit, and the difference was not statistically significant.

To account for the possibility that the two groups differed in ways that could confound the comparison — differences in tumor size, nodal involvement, grade, or the type of endocrine therapy received — the team performed multivariate analysis, a statistical technique that adjusts for multiple variables simultaneously. The result was unambiguous: ovarian function suppression showed no independent association with disease-free survival, distant disease-free survival, or overall survival once other factors were taken into account. The authors are careful to note, however, that the study’s statistical power was limited. With 138 patients and relatively few events — 20 recurrences and 11 deaths — the analysis simply cannot exclude a modest benefit that a larger trial might detect.

Another critical caveat concerns the composition of the endocrine therapy itself. The cohort was predominantly treated with tamoxifen, the selective estrogen receptor modulator that has long been the backbone of adjuvant therapy in premenopausal women. Whether ovarian suppression paired with aromatase inhibitors — a more aggressive regimen that eliminates nearly all estrogen production — would perform differently cannot be answered by this dataset. The authors explicitly caution that, given the limited statistical power and the tamoxifen-dominated treatment landscape, their findings should be interpreted with care, and they call for prospective studies to define the role of ovarian suppression in this population with the rigor that only randomized designs can provide.

For clinicians and patients, the practical message is one of individualized decision-making rather than a blanket rule. Ovarian suppression is not a free intervention: it induces a premature, often abrupt menopause, bringing hot flashes, bone density loss, sexual dysfunction, and potential effects on fertility and quality of life. If a young woman achieves a pathological complete response after neoadjuvant anti-HER2 therapy, the data suggest her prognosis is excellent without intensification, and she and her physician may reasonably weigh the burden of suppression against its uncertain benefit. For those with residual disease, the numerically better overall survival observed with suppression — though not statistically significant — may still inform a shared decision, particularly for patients with other high-risk features. What this single-center experience ultimately demonstrates is that the era of effective anti-HER2 therapy has changed the calculus of endocrine intensification, and that the questions guiding treatment for premenopausal, hormone receptor-positive, HER2-positive breast cancer are now as much about avoiding overtreatment as about maximizing it. Larger, prospective trials will be needed to settle the matter definitively, but for now, this study offers a data-driven reminder that more intensive therapy is not always better therapy.

Subject of Research: Ovarian function suppression in adjuvant endocrine therapy for premenopausal hormone receptor-positive, HER2-positive breast cancer after neoadjuvant anti-HER2 therapy

Article Title: The effect of adding ovarian function suppression to adjuvant endocrine therapy in premenopausal patients with hormone receptor-positive, HER2-positive breast cancer who have undergone neoadjuvant therapy: a single-center experience

Article References: Aydin, O., Dogan, H. G. Y., Sonusen, S. D., Erciyestepe, M., Ozturk, A. E., Buyukkuscu, A., Isleyen, Z. S., & Erturk, K. (2026). The effect of adding ovarian function suppression to adjuvant endocrine therapy in premenopausal patients with hormone receptor-positive, HER2-positive breast cancer who have undergone neoadjuvant therapy: a single-center experience. BMC Cancer, 26(1), Article 1140. https://doi.org/10.1186/s12885-026-17017-8

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17017-8

Keywords: breast cancer, HER2-positive, hormone receptor-positive, ovarian function suppression, neoadjuvant therapy, adjuvant endocrine therapy, pathological complete response, disease-free survival, overall survival, tamoxifen, premenopausal, oncology

The study drew on data from 356 women who had been diagnosed with breast cancer and were interviewed five years later as part of the VICAN5 survey, a large French national cohort designed to follow cancer survivors’ lives across health, work, and psychosocial domains. To characterize sexual dysfunction, the researchers selected five items from the Relationship and Sexuality Scale, a validated instrument covering dimensions of sexual life relevant to cancer survivors. Because sexual dysfunction is multidimensional, encompassing desire, arousal, comfort, and satisfaction, the team applied latent class analysis, a data-driven method that identifies unobserved subgroups within a population based on patterns of responses across multiple indicators. Instead of imposing arbitrary cutoff scores, latent class analysis lets the data reveal how symptoms cluster together in real people.

The analysis pointed decisively to a three-class model. The largest group, comprising 133 women or 37.4 percent of the sample, experienced moderate sexual dysfunction. A second group of 124 women, or 34.8 percent, reported no or low dysfunction. But the third group, 99 women representing 27.8 percent of survivors, reported high sexual dysfunction five years after diagnosis. In other words, nearly two-thirds of women in remission carried at least a moderate burden of sexual problems, and more than one in four carried a heavy one, at a point in their care when routine oncology follow-up has typically shifted focus to surveillance for recurrence rather than quality-of-life issues.

To understand what distinguished women in the higher-severity classes, the researchers used ordinal logistic regression, a statistical approach suited to outcomes that fall into ordered categories, in this case the ordered severity classes of dysfunction. The strongest association by far was psychological: women who reported feeling less sexually attractive had nearly five times the odds of belonging to a higher dysfunction class, with an adjusted odds ratio of 4.72. This finding places body image at the center of the sexual health picture for breast cancer survivors, consistent with a broader literature linking surgical scars, hair loss, weight changes, and altered breast sensation to diminished sexual self-concept and avoidance of intimacy.

Treatment exposures also left measurable marks. Women who had received radiotherapy had 2.36 times the odds of higher dysfunction, and those still taking adjuvant endocrine therapy at the time of the survey had 1.87 times the odds. Endocrine therapies, including tamoxifen and aromatase inhibitors, are taken for years and work by suppressing estrogen signaling, which can induce menopausal symptoms such as vaginal dryness, hot flashes, and decreased libido even in premenopausal women. The finding that current endocrine therapy use remained associated with sexual dysfunction at five years underscores that these drugs’ side effects are not transient inconveniences but persistent burdens that can erode adherence and quality of life.

Persistent physical symptoms emerged as another cluster of risk factors. Women reporting frequent excessive sweating had 1.67 times the odds of higher dysfunction, and those with frequent paresthesia, abnormal tingling or numbness in the breast or arm, had 1.78 times the odds. Both symptoms point to lasting physiological changes from treatment: vasomotor instability driven by endocrine effects, and nerve injury or sensory loss following surgery and radiation. Breast and nipple sensation plays a documented role in sexual response, and its loss is increasingly recognized as a distinct outcome, sometimes described as sensorisexual function, that deserves attention in its own right rather than being dismissed as a minor sensory change.

The analysis also flagged factors that might be modifiable. Women diagnosed after age 50 had 2.30 times the odds of higher dysfunction, a finding that likely reflects the interplay of natural menopause with treatment-induced hormonal changes. Frequent alcohol consumption was associated with 2.00 times the odds, and use of hypnotic medications, typically prescribed for sleep disturbance, with 1.66 times the odds. The hypnotic finding is particularly intriguing because sedative-hypnotic drugs have known effects on sexual function, and sleep disorders themselves are linked to sexual problems in women. Whether hypnotics are a cause, a marker of underlying distress, or both cannot be resolved in a cross-sectional analysis, but the association suggests that sleep management in survivors may have benefits that extend beyond rest.

The VICAN5 cohort itself deserves attention as a model for survivorship research. Funded by the French National Institute of Cancer, the VICAN surveys followed nationally representative samples of cancer patients at two and five years after diagnosis, capturing not only clinical outcomes but employment, social life, and intimate relationships. This breadth allowed the current analysis to situate sexual dysfunction within women’s whole lives rather than within the clinic alone. The study was approved by French ethics and data protection authorities, and all participants gave informed consent, meeting the standards expected of research touching on highly personal subject matter.

Certain limitations temper the conclusions. The analysis is cross-sectional, meaning it captures a single snapshot at five years and cannot establish whether the associated factors preceded the dysfunction or followed from it. The five RSS items, while validated, provide a narrower window on sexual function than comprehensive instruments such as the Female Sexual Function Index, and the sample of 356 women, though drawn from a national survey, may not represent all survivors, particularly those who declined to answer questions about sexuality. Sexual health questions are notoriously subject to underreporting, which means the true prevalence of dysfunction could be even higher than the study suggests.

Even with those caveats, the message for clinical practice is clear and increasingly urgent. The authors argue that sexual health assessment should be built into routine survivorship care for breast cancer, including dedicated oncosexual consultations, psychosexual support for body image concerns, and active management of persistent treatment symptoms such as vasomotor complaints and neuropathic sensations. Recent trials of newer agents for endocrine-therapy-related vasomotor symptoms show that effective options are emerging, and evidence-based non-pharmacological approaches to sleep and distress are available. What has been missing, the study implies, is the will to ask. Most survivors are never asked about their sexual lives by their oncology teams, and most do not raise the topic themselves. A simple, structured screening question at follow-up visits, targeted especially at women reporting feeling less sexually attractive or struggling with persistent symptoms, could open a door that too many women have been left to face alone.

Subject of Research: Patterns and predictors of sexual dysfunction among breast cancer survivors five years after diagnosis

Article Title: Patterns of sexual dysfunction among breast cancer survivors five years after diagnosis: a latent class analysis of the French VICAN5 study

Article References: Radwan, E., Seguin, L., Provansal, M., Mancini, J., & Bouhnik, A.-D. (2026). Patterns of sexual dysfunction among breast cancer survivors five years after diagnosis: a latent class analysis of the French VICAN5 study. Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-026-02108-z

Image Credits: AI Generated

DOI: 10.1007/s11764-026-02108-z

Keywords: breast cancer survivors, sexual dysfunction, latent class analysis, VICAN5, adjuvant endocrine therapy, body image, radiotherapy, paresthesia, vasomotor symptoms, survivorship care, hypnotic use, quality of life