Open Access Open Badges Research article

Association of functional polymorphisms in CYP19A1 with aromatase inhibitor associated arthralgia in breast cancer survivors

Jun J Mao12*, H Irene Su3, Rui Feng4, Michelle L Donelson4, Richard Aplenc5, Timothy R Rebbeck24, Frank Stanczyk6 and Angela DeMichele246

Author Affiliations

1 Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, 3400 Spruce Street/2 Gates, Philadelphia, PA 19104, USA

2 Abramson Cancer Center, University of Pennsylvania School of Medicine, 3400 Spruce Street/2 Gates, Philadelphia, PA 19104, USA

3 Department of Reproductive Medicine, University of California School of Medicine, San Diego, 3855 Health Sciences Drive, Dept. 0901, La Jolla, CA 92093-0901, USA

4 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 423 Guardian Drive, Philadelphia, PA 19104, USA

5 Department of Hematology/Oncology, Children's Hospital of Philadelphia, 4018 CTRB, 3501 Civic Center Boulevard, Philadelphia PA 19104, USA

6 Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania School of Medicine, Perelman Center, 3rd Floor, 3400 Civic Center Blvd., Philadelphia, PA 19104, USA

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Breast Cancer Research 2011, 13:R8  doi:10.1186/bcr2813

Published: 20 January 2011



Aromatase inhibitor-associated arthralgia (AIAA) is a common and often debilitating symptom in breast cancer survivors. Since joint symptoms have been related to estrogen deprivation through the menopausal transition, we hypothesized that genetic polymorphisms in CYP19A1, the final enzyme in estrogen synthesis, may be associated with the occurrence of AIAA.


We performed a cross-sectional study of postmenopausal women with stage 0 to III breast cancer receiving adjuvant aromatase inhibitor (AI) therapy. Patient-reported AIAA was the primary outcome. DNA was genotyped for candidate CYP19A1 polymorphisms. Serum estrogen levels were evaluated by radioimmunoassay. Multivariate analyses were performed to examine associations between AIAA and genetic variants controlling for possible confounders.


Among 390 Caucasian participants, 50.8% reported AIAA. Women carrying at least one 8-repeat allele had lower odds of AIAA (adjusted odds ratio (AOR) 0.41, 95% confidence interval (CI) 0.21 to 0.79, P = 0.008) after adjusting for demographic and clinical covariates. Estradiol and estrone were detectable in 47% and 86% of subjects on AIs, respectively. Although these post-AI levels were associated with multiple genotypes, they were not associated with AIAA. In multivariate analyses, women with more recent transition into menopause (less than five years) were significantly more likely to report AIAA than those greater than ten years post-menopause (AOR 3.31, 95% CI 1.72 to 6.39, P < 0.001).


Functional polymorphism in CYP19A1 and time since menopause are associated with patient-reported AIAA, supporting the hypothesis that the host hormonal environment contributes to the pathophysiology of AAIA. Prospective investigation is needed to further delineate relationships between host genetics, changing estrogen levels and AIAA.