Endometrial changes in postmenopausal women treated with tamoxifen for breast cancer

Cohen, Ilan; Rosen, Doron J.D.; Shapira, Jeremiah; Cordoba, Mario; Gilboa, Shlomo; Altaras, Marco M.; Dror, Yigal; Beyth, Y

doi:10.1016/0020-7292(94)90778-1

Cited by 14 publications

(36 citation statements)

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“…6 8-11 Although the incidence of overall endometrial pathology of 24.6% detected in the gynaecologically asymptomatic tamoxifen treated patients was lower than that found in similar gynaecologically symptomatic patients, it is similar to that reported in our previous studies with smaller numbers of patients, 5 37 38 There are only three published reports, on relatively small numbers of patients, comparing endometrial histology between these two types of patients. 12 14 15 Borenstein et al found no endometrial abnormalities in any of 15 gynaecologically asymptomatic postmenopausal breast cancer patients treated with tamoxifen.…”

Section: Discussionsupporting

confidence: 58%

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Endometrial pathology in postmenopausal tamoxifen treatment: comparison between gynaecologically symptomatic and asymptomatic breast cancer patients.

et al. 1999

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Aims-To evaluate whether endometrial pathology is more likely to be diagnosed in gynaecologically symptomatic rather than in gynaecologically asymptomatic postmenopausal breast cancer patients with tamoxifen treatment; and to evaluate the possible influence of various clinical factors on the incidence of endometrial pathology. Methods-Endometrial histological findings, transvaginal ultrasonographic endometrial thickness, demographic characteristics, health habits, and risk factors for endometrial cancer were compared between 14 gynaecologically symptomatic (group I) and 224 gynaecologically asymptomatic (group II) postmenopausal breast cancer patients with tamoxifen treatment. Results-Overall, 28.6% of the study population had endometrial pathology. The incidence of overall positive endometrial histological findings was significantly higher in group I than in group II (92.9% v 24.6%, p < 0.0001). Atrophic endometrium was more common in group II than in group I (75.3% v 7.1%, p < 0.0001). Most other endometrial pathology was significantly more common in group I than in group II (endometrial hyperplasia, 35.7% v 5.6%, p < 0.0001; endometrial polyps, 35.7% v 13.4%, p < 0.0111; endometrial carcinoma, 21.5% v 0.9%, p < 0.0001). Endometrial pathology appeared considerably later in the gynaecologically asymptomatic patients than in gynaecologically symptomatic patients (p = 0.0002). Vaginal bleeding or spotting occurred exclusively in group I. The incidence of endometrial pathology in the entire study population was consistent with that reported elsewhere, and higher than that reported for healthy postmenopausal women. Conclusions-Endometrial pathology is more likely to be diagnosed in gynaecologically symptomatic postmenopausal breast cancer patients with tamoxifen treatment, and after a shorter duration of time, than in gynaecologically asymptomatic patients. (J Clin Pathol 1999;52:278-282)

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Section: Discussionsupporting

confidence: 58%

“…5 Archer et al found distinctly fewer pathological endometrial findings among 801 healthy postmenopausal women. 42 In this study we also compared transvaginal sonographic endometrial thickness, demographic characteristics, health habits, and risk factors for endometrial cancer between the two study groups.…”

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confidence: 95%

Endometrial pathology in postmenopausal tamoxifen treatment: comparison between gynaecologically symptomatic and asymptomatic breast cancer patients.

et al. 1999

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“…Employing DNA flow cytometry, TAM-induced endometrial proliferation in premenopausal women seems to be restricted to the stromal components (8), although the observed tumors in postmenopausal women are frequently of epithelial origin (11). The mechanism of induction is generally considered to be hormonal (11), and, in fact, a significant number of postmenopausal women on TAM therapy show estrogen-like changes (7,25). TAM induces uterine cancer in neonatally treated mice (32), and in the rat it is a strong liver carcinogen (13,19,35).…”

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The Proliferation in Uterine Compartments of Intact Rats of Two Different Strains Exposed to High Doses of Tamoxifen or Toremifene

et al. 1998

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Uterine Cell proliferation was studied in intact Sprague-Dawley (SD) and Fischer 344 (F344) rats exposed to the antiestrogens tamoxifen (TAM; 5, 10, 20, or 40 mg/kg) and toremifene (TOR: 21.2 or 42.4 mg/kg). The antiestrogens were administered to animals via gavage daily for 2 or 12 wk. Uterine proliferation was assessed using markers for the proliferating cell nuclear antigen (PCNA) and by the bromodeoxyuridine (BrdU) method. Diethylstilbestrol (DES) was used as an estrogenic reference compound. The antiestrogens either reduced or prevented changes of myometrial and stromal proliferation indices (PI). TAM and TOR caused a time-dependent reduction of endometrial glands without an associated decrease in cell proliferation. In the luminal columnar epithelium, the antiestrogens depressed PCNA PI but enhanced BrdU PI, indicating a low continuous DNA synthesis in otherwise quiescent cells. The antiestrogens induced focal hyperplastic multilayered epithelia with PCNA-positive basal cells along segments of the luminal uterine epithelium. We suggest that this hyperplastic epithelium represents remnants from the glandular epithelium. DES was less efficient in inducing these changes but induced squamous metaplasias in the F344 rats. Uterine effects of the 2 antiestrogens were comparable with the exception of I TAM-exposed (40 mg/kg) SD rat that showed squamous metaplasia. F344 rats were more sensitive to the estrogenic action of DES than were the SD rats.

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“…In one study, an endometrial biopsy was attempted in 77 tamoxifen treated postmenopausal breast cancer patients, but adequate endometrial tissue was obtained in only 22 cases (29%), even though 76 women had an ultrasonographically thickened endometrium. 17 Nevertheless, it appears that tamoxifen treated postmenopausal breast cancer patients have a significantly higher incidence of proliferative endometrial abnormalities (endometrial hyperplasia, polyps, and malignant neoplasms) than untreated postmenopausal women with breast cancer. ENDOMETRIAL HYPERPLASIA Normal postmenopausal endometrium is atrophic.…”

Section: Cervical Evects Of Tamoxifenmentioning

confidence: 99%

Gynaecological effects of tamoxifen.

Ismail¹

1999

J Clin Pathol

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Endometrial changes in postmenopausal women treated with tamoxifen for breast cancer

Cited by 14 publications

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Endometrial pathology in postmenopausal tamoxifen treatment: comparison between gynaecologically symptomatic and asymptomatic breast cancer patients.

Endometrial pathology in postmenopausal tamoxifen treatment: comparison between gynaecologically symptomatic and asymptomatic breast cancer patients.

The Proliferation in Uterine Compartments of Intact Rats of Two Different Strains Exposed to High Doses of Tamoxifen or Toremifene

Gynaecological effects of tamoxifen.

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