Endometrial findings in postmenopausal breast cancer patients receiving tamoxifen

Lahti, Eija I.; Blanco, Guillermo; Kauppila, Antti; Laatikainen, Timo

doi:10.1016/0028-2243(93)90128-y

Cited by 34 publications

(55 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Tamoxifen has an effect on the endometrium that varies with the serum estradiol (E2) concentration in that it will function as an estrogen agonist only in postmenopausal women. [17][18][19][20] An increased risk of endometrial carcinoma has been described, specifically in postmenopausal women, and the risk increases with cumulative dose and duration of tamoxifen treatment. 6,[21][22][23][24][25] Cheng et al compared the endometrial findings of pre-and post-menopausal women receiving tamoxifen therapy with abnormal bleeding.…”

Section: -15mentioning

confidence: 99%

The effect of adjuvant hormonal therapy on the endometrium and ovary of breast cancer patients

2008

View full text Add to dashboard Cite

Objective:To investigate the effect of adjuvant hormonal therapy on the endometrium and ovary of breast cancer patients. Methods: A retrospective review was performed on the 207 patients who had taken tamoxifen or anastrozole, as adjuvant hormonal therapy after breast cancer surgery between January 2003 and December 2006. Gynecologic surveillance constituted of ultrasonographic exam of the endometrial thickness and ovarian cyst formation. The patients were classified into three groups and analyzed; premenopausal/postmenopausal women receiving tamoxifen and women receiving anastrozole. Results: Mean duration of follow up?was 20.6±6.6 months. There was no difference of mean endometrial thickness before hormonal therapy among the three groups (p=0.327). In women receiving tamoxifen, the endometrium was continuously thickened in proportion to the duration of the therapy irrespective of menopausal status while it remained unchanged in women receiving anastrozole (p＜0.05). Endometrial biopsies were performed in 28 patients receiving tamoxifen. The most common histologic finding was proliferative endometrium in premenopausal women (7/21) and atrophic endometrium in postmenopausal women (6/7). There was no case of endometrial cancer in both groups. Ovarian cyst was found in 32 women and the most were developed in premenopausal women receiving tamoxifen (30/32). All of them showed benign nature on transvaginal ultrasonographic findings. Conclusion: Women undergoing adjuvant hormonal therapy after breast cancer surgery exhibited changes in the endometrium and ovary. However most changes were not a serious problem in this study and frequent gynecologic surveillance in these patients needs further investigation.

show abstract

Section: -15mentioning

confidence: 99%

The effect of adjuvant hormonal therapy on the endometrium and ovary of breast cancer patients

2008

View full text Add to dashboard Cite

show abstract

“…There have been many reports of abnormalities identified in the endometrium in women on tamoxifen including hyperplasia with atypia and polyps, some of which are similar to the changes seen with ERT (Cross and Ismail, 1990;Neven et al, 1990;De Muylder et al, 1991;Cohen et al, 1993;Lahti et al, 1993;Neven, 1993;Ismail, 1994;Aleem and Predanic, 1995).…”

mentioning

confidence: 92%

The effects of norethisterone on endometrial abnormalities identified by transvaginal ultrasound screening of healthy post-menopausal women on tamoxifen or placebo

Powles

Bourne²,

Athanasiou³

et al. 1998

Br J Cancer

View full text Add to dashboard Cite

Summary Tamoxifen (tam) is used extensively for treatment of patients with breast cancer and is being evaluated for chemoprevention in healthy women. It has, however, been reported to increase the risk of endometrial cancer in post-menopausal women, probably by an oestrogenic effect on the endometrium. It also causes endometrial cysts and polyps. The aims of this study were to identify the incidence of endometrial thickening, polyps and cysts by transvaginal ultrasound (TVUS) screening of a population of post-menopausal healthy women in the Royal Marsden tamoxifen chemoprevention trial and to evaluate the possible benefit from the use of intermittent norethisterone (NE) in women with persistent changes. Since 1990, we have undertaken regular TVUS, using an endovaginal B mode probe, of the 463 postmenopausal women in the trial randomized to tam (20 mg day-') or placebo (plac), without breaking the randomization code. Endometrial thickening (ET) was defined as .8 mm at the widest point across the myometrial cavity in the longitudinal plane, including any stromal changes. Cystic changes were defined as more than one hypoechogenic area > 1 mm. Polyps were identified using saline hydrosonography. Oral NE (2.5 mg day-1) was used for 21 days out of 28 for three consecutive cycles by women with persistent endometrium . 8 mm, including cystic and polypoid changes. TVUS was repeated after the three courses to evaluate any change caused by NE and endometrial biopsies, including hysteroscopy, was performed on those women with persistent abnormalities. A persistent ET . 8 mm was identified in 56 (24%) of the 235 women on tamoxifen compared with only 5 (2%) of 228 women on placebo (P <0.0005). Stromal changes, including cysts, were detected in 36 (15%) and polyps in 26 (11%) of the women on tamoxifen compared with only two (<1%) of the women on placebo (P << 0.0005). After 3 months of cyclical norethisterone, 39 of 47 women (83%) on tamoxifen had persistent ultrasound changes. However, 45 (96%) had a progesterone withdrawal bleed. Hysteroscopy was performed in 39 women on tamoxifen (28 endometrial biopsy, 15 polypectomy), five of whom had histological evidence of a proliferative endometrium and a further three had an atypical hyperplastic endometrium (one of whom had a focus of invasive carcinoma). The cysts and polyps which were detected in women on tam could not be reversed by NE and were presumably stromal and not of malignant risk. However, 96% of the women had withdrawal NE bleeding, indicating an oestrogenically primed endometrium which could be a mechanism for an increased risk of endometrial cancer. Further studies are required to ascertain whether a progestin would protect against this risk. As in other studies, these results indicate that any increased risk of endometrial cancer caused by tamoxifen is low, and that TVUS screening is probably not justified for asymptomatic women on tamoxifen. Group, 1992). Based on these findings, it is now widely used and many millions of women have had, or are now receiving, such ...

show abstract

“…In the uterus, and especially in the endometrium, the effect of antioestrogens resembles that of oestrogens (Lahti et al, 1993;Friedl and Jordan, 1994), and in this regard tamoxifen may be more potent than toremifene at least in animal experiments (DiSalle et al, 1990). The use of both tamoxifen and toremifene has been linked to the risk of endometrial polyps (Tomás et al, 1995;Barakat, 1996) and tamoxifen may increase the risk of endometrial cancer (Fisher et al, 1994;Rutqvist et al, 1995;Fisher et al, 1998;Early Breast Cancer Trialists Collaborative Group, 1998).…”

mentioning

confidence: 99%

Prospective study on gynaecological effects of two antioestrogens tamoxifen and toremifene in postmenopausal women

et al. 2001

View full text Add to dashboard Cite

To assess and compare the gynaecological consequences of the use of 2 antioestrogens we examined 167 postmenopausal breast cancer patients before and during the use of either tamoxifen (20 mg/day, n = 84) or toremifene (40 mg/day, n = 83) as an adjuvant treatment of stage II–III breast cancer. Detailed interview concerning menopausal symptoms, pelvic examination including transvaginal sonography (TVS) and collection of endometrial sample were performed at baseline and at 6, 12, 24 and 36 months of treatment. In a subgroup of 30 women (15 using tamoxifen and 15 toremifene) pulsatility index (PI) in an uterine artery was measured before and at 6 and 12 months of treatment. The mean (±SD) follow-up time was 2.3 ± 0.8 years. 35% of the patients complained of vasomotor symptoms before the start of the trial. This rate increased to 60.0% during the first year of the trial, being similar among patients using tamoxifen (57.1%) and toremifene (62.7%). Vaginal dryness, which was present in 6.0% at baseline, increased during the use of tamoxifen (26.2%) and toremifene (24.1%). Endometrial thickness increased from baseline (3.9 ± 2.7 mm) to 6.8 ± 4.2 mm at 6 months ( P < 0.001), and no difference emerged between the 2 regimens in this regard. Before the start of the antioestrogen regimen, the endometrium was atrophic in 71 (75.5%) and proliferative in 19 of 94 (20.2%) samples; 4 patients had benign endometrial polyps. During the use of antioestrogen altogether 339 endometrial samples were taken (159 in tamoxifen group, 180 in toremifene group). The endometrium was proliferative more often in the tamoxifen group (47.8%) than in the toremifene group (32.2%) ( P < 0.0001). 20 patients had a total of 24 polyps (17 in tamoxifen and 9 in toremifene group, P < 0.05) during the use of antioestrogens. One patient in the toremifene group developed endometrial adenocarcinoma at 12 months, and one patient had breast cancer metastasis on the endometrium. Tamoxifen failed to affect the PI in the uterine artery, but toremifene reduced it by 15.0% ( P < 0.05) by 12 months. In conclusion, tamoxifen and toremifene cause similarly vasomotor and vaginal symptoms. Neither regimen led to the development of premalignant endometrial changes. Our data suggest that so close endometrial surveillance as used in our study may not be mandatory during the first 3 years of use of antioestrogen treatment. © 2001 Cancer Research Campaign http://www.bjcancer.com

show abstract

Endometrial findings in postmenopausal breast cancer patients receiving tamoxifen

Cited by 34 publications

References 0 publications

The effect of adjuvant hormonal therapy on the endometrium and ovary of breast cancer patients

The effect of adjuvant hormonal therapy on the endometrium and ovary of breast cancer patients

The effects of norethisterone on endometrial abnormalities identified by transvaginal ultrasound screening of healthy post-menopausal women on tamoxifen or placebo

Prospective study on gynaecological effects of two antioestrogens tamoxifen and toremifene in postmenopausal women

Contact Info

Product

Resources

About