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Follow-up in patients on tamoxifen


Authors: as. MUDr. Jiří Bouda, Ph.D. 1;  MUDr. Jiří Štěpán 1;  MUDr. Tomáš Svoboda 2;  doc. MUDr. Zdeněk Rokyta, CSc. 1
Authors‘ workplace: Gynekologicko-porodnická klinika LF UK a FN Plzeň 1;  radioterapeutické oddělení FN Plzeň 2
Published in: Prakt Gyn 2006; 10(2): 60-63

Overview

Tamoxifen is the most frequently used drug in hormonal treatment of breast cancer. Follow-up of patients on tamoxifen is controversial and it has no universal guidelines. We analyze a group of 74 patients on tamoxifen indicated for hysteroscopy for abnormal ultrasonography (USG; 71.6%), abnormal uterine bleeding (AUB; 6.8%), abnormal USG and AUB (10.8%), or other indications (10.8%). Histological examination revealed four times (5.4%) simple non-atypical hyperplasia, six times (8.1%) endometrial polyp with simple non-atypical hyperplasia, and one time (1.4%) well differentiated endometroid endometrial carcinoma, other findings (85.1%) were atrophic, proliferative, and secretory endometrium or atrophic endometrial polyp. Ultrasound was not significant for endometrial pathology. 46% patients with AUB had clinically relevant endometrial pathology comparing to 11.5% clinically relevant pathologies in asymptomatic patients. We show a high rate of false positivity of USG and the importance of AUB as a symptom of endometrial pathology in our patient series. The examination at the beginning of the treatment and its dynamic changes during follow-up are important. USG is a basic diagnostic method of follow-up, hysteroscopy is the best diagnostic and therapeutical method for any endometrial pathology.

Key words:
breast cancer – tamoxifen – hormonal treatment – ultrasonography – hysteroscopy


Sources

Labi FL, Meggiorini ML, Nusiner MP et al. Cytologic endometrial surveillance in tamoxifen-treated women. Eur J Gynaecol Oncol 2002; 23: 537-539.

2. Giorda G, Crivellari D, Veronesi A et al. Comparison of ultrasonography, hysteroscopy, and biopsy in the diagnosis of endometrial lesions in postmenopausal tamoxifen-treated patients. Acta Obstet Gynecol Scand 2002; 81: 975-980.

3. Yuce K, Tuncer ZS, Onculoglu C et al. Reproductive tract pathology in asymptomatic women treated with tamoxifen. Eur J Gynaecol Oncol 2001; 22: 466-468.

4. Lhomme C, Pautier P, Zagame L et al. Endometrial surveillance of women on tamoxifen. Gynecol Obstet Fertil 2003; 31: 647-656.

5. Burkart C, Wight E, Pok J et al. Ultrasound endometrium follow-up during tamoxifen treatment: Really not reliable or useful after all? Ultraschall Med 2001; 22: 136-142.

6. Zarbo G, Caruso G, Zammitti M et al. The effects of tamoxifen therapy on the endometrium. Eur J Gynaecol Oncol 2000; 21: 86-88.

7. Gerber B, Krause A, Muller H et al. Effects of adjuvant tamoxifen on the endometrium in postmenopausal women with breast cancer: a prospective long-term study using transvaginal ultrasound. J Clin Oncol 2000; 18: 3464-3470.

8. Ismail SM. Pathology of endometrium treated with tamoxifen. J Clin Pathol 1994; 47: 827-833.

9. Neven P, De Muylder X, Van Belle Y et al. Longitudinal hysteroscopic follow-up during tamoxifen treatment. Lancet 1998; 351: 36.

10. Fornander T, Rutqvist LE, Cedermark B, et al. Adjuvant tamoxifen in early breast cancer: occurrence of new primary cancers. Lancet 1989; 1: 117-120.

11. Rutqvist LE, Mattsson A. Cardiac and thromboembolic morbidity among postmenopausal women with early-stage breast cancer in a randomized trial of adjuvant tamoxifen. The Stockholm Breast Cancer Study Group. J Natl Cancer Inst 1993; 85: 1398-1406.

12. Fisher B, Costantino JP, Redmond CK et al. Endometrial cancer in tamoxifen-treated breast cancer patients: findings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14. J Natl Cancer Inst 1994; 86: 527-537.

13. Magriples U, Naftolin F, Schwartz PE et al. High-grade endometrial carcinoma in tamoxifen-treated breast cancer patients. J Clin Oncol 1993; 11: 485-490.

14. Valenzano M, Bertelli GF, Costantini S et al. Transvaginal ultrasonography and hysterosonography to monitor endometrial effects in tamoxifen-treated patients. Eur J Gynaecol Oncol 2001; 22: 441-444.

15. Fung MF, Reid A, Faught W et al. Prospective longitudinal study of ultrasound screening for endometrial abnormalities in women with breast cancer receiving tamoxifen. Gynecol Oncol 2003; 91: 154-159.

16. Gardner FJ, Konje JC, Brown L et al. Uterine surveillance of asymptomatic postmenopausal women taking tamoxifen. Climacteric 1998; 1: 180-187.

17. Suh-Burgmann EJ, Goodman A. Surveillance for endometrial cancer in women receiving tamoxifen. Ann Intern Med 1999; 131: 127-135.

18. Richenberg J CP. Ultrasound of the Uterus. In: Callen PW (ed). Ultrasound in Obstetrics and Gynecology. 4th ed. Philadelphia: WB Saunders 2000: 841-842.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
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