Baseline endometrial assessment before tamoxifen for breast cancer in asymptomatic menopausal women

Garuti, Giancarlo; Cellani, Fulvia; Centinaio, Giovanna; Sita, Giulia; Nalli, G; Luerti, Massimo

doi:10.1016/j.ygyno.2005.03.036

Cited by 26 publications

(15 citation statements)

References 26 publications

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“…Epidemiological studies from our group and others have convincingly shown that there is an increased risk to develop uterine corpus cancer after tamoxifen exposure, especially after prolonged use (Bergman et al, 2000;Swerdlow and Jones, 2005;Garuti et al, 2005;Lindahl et al, 2008). In addition, it was shown that these tumors have less favorable histological features and are associated with worse survival (Hoogendoorn et al, 2008).…”

Section: Discussionmentioning

confidence: 90%

Genomic profile of endometrial tumors depends on morphological subtype, not on tamoxifen exposure

Fles

Hoogendoorn²,

Platteel

et al. 2010

Genes Chromosomes & Cancer

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Tamoxifen has been a very effective treatment for breast cancer for several decades, however, at the same time increases the risk of endometrial cancer, especially after prolonged exposure. In addition, tamoxifen has been associated with a higher proportion of unfavorable uterine tumor subtypes (carcinosarcomas and serous adenocarcinomas) with worse survival. We investigated whether endometrial tumors, which developed after prolonged tamoxifen treatment for breast cancer, are genetically different from endometrial tumors without preceding tamoxifen exposure. Array CGH was used on archival formalin-fixed paraffin embedded endometrial tumors to determine genomic aberrations. We compared the genomic profiles of 52 endometrial tumors from breast cancer patients after long-term (>or=2 years) tamoxifen use (endometrioid adenocarcinomas, n = 26; carcinosarcomas, n = 14; and serous adenocarcinomas, n = 12) with endometrial tumors from unexposed breast cancer patients (n = 45). Genomic profiles were correlated with tamoxifen exposure, tumor subtypes, and histopathological characteristics of the endometrial tumors. The common uterine corpus cancers of the endometrioid subtype show few genomic aberrations. Tumors with many genomic aberrations were in general ER-negative. In contrast, carcinosarcomas and serous adenocarcinomas showed many aberrations; however, they were indistinguishable from each other. Tumors that developed after prolonged tamoxifen use did not show more or different aberrations than unexposed tumors. This was true for all tumor subtypes. Thus, endometrial carcinomas that develop after prolonged tamoxifen use cannot be distinguished from nonusers on basis of their tumor genomic profile.

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Section: Discussionmentioning

confidence: 90%

Genomic profile of endometrial tumors depends on morphological subtype, not on tamoxifen exposure

Fles

Hoogendoorn²,

Platteel

et al. 2010

Genes Chromosomes & Cancer

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“…Initially I had to rely on a personal communication (A. Parsons, central ultrasonography reader for the Raloxifene Uterine Safety Study) to know that 10% of healthy postmenopausal patients coming to be evaluated for an osteoporosis selective estrogen receptor modulator (SERM) trial were excluded because they had unsuspected asymptomatic polyps diagnosed on sonohysterography. Then some Europeans studies 31,32 found that newly diagnosed postmenopausal patients with breast cancer had an incidence of endometrial polyps of 11-17%.…”

Section: What About the Nonbleeding Postmenopausal Patient With An Inmentioning

confidence: 99%

Modern Evaluation of the Endometrium

Goldstein

2010

Obstetrics &Amp; Gynecology

115

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Abnormal uterine bleeding in women older than age 35 years, and certainly in menopausal patients, mandates evaluation, mainly to exclude cancer and hyperplasia, but also to better diagnose the source of the bleeding to appropriately manage the patient. In the past, dilation and curettage was the mainstay of diagnosis. This gave way to in-office suction pump-generated biopsies. Most recently, disposable biopsy instruments with their own internal piston to generate suction have become the standard of care. Rarely has such a technique received such widespread acceptance with such limited validation. Transvaginal ultrasonography, when technically feasible, is a noninvasive way to image the endometrial cavity. Saline-infusion sonohysterography is a subset of transvaginal ultrasonography reserved for patients in whom an adequate endometrial echo is not seen or when an endometrial echo is seen but not sufficiently thin. Appropriate understanding and use of transvaginal ultrasonography and addition of sonohysterography when necessary can allow a clinical algorithm that can triage patients with abnormal uterine bleeding to 1) no anatomic pathology best treated expectantly; 2) a global endometrial process, in which case random blind endometrial sampling is appropriate; or 3) a focal endometrial abnormality in which case endometrial sampling should be done with the visualization offered by hysteroscopy. Finally, the incidence of thick endometrial echo found incidentally in postmenopausal women with no bleeding is extremely high (10-17%) and should not trigger invasive endometrial sampling automatically.

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“…29 They are higher than 15.3%, 17.4%, 18.0%, and 18.6% of patients reported in other series 6,15,19,20 ; and are much more than the lower rates of baseline pathology ranging from 3.3% to 13.0% reported by other authors. 14<17,31 In two studies, 17,33 no endometrial abnormalities were found before the start of TAM administration.…”

Section: Discussionmentioning

confidence: 55%

Baseline hysteroscopic assessment of endometrium in asymptomatic postmenopausal women with estrogen receptor–positive breast cancer

et al. 2013

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Baseline endometrial assessment before tamoxifen for breast cancer in asymptomatic menopausal women

Cited by 26 publications

References 26 publications

Genomic profile of endometrial tumors depends on morphological subtype, not on tamoxifen exposure

Genomic profile of endometrial tumors depends on morphological subtype, not on tamoxifen exposure

Modern Evaluation of the Endometrium

Baseline hysteroscopic assessment of endometrium in asymptomatic postmenopausal women with estrogen receptor–positive breast cancer

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