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

Abstract

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)

Src Kinase and Mitogen-Activated Protein Kinases in the Progression from Normal to Malignant Endometrium

“…However, tamoxifen exhibits an estrogen agonist action in the endometrium and stimulates endometrial proliferation likely through the stromal compartment (29). This observation could explain the increased incidence of abnormal endometrial proliferations (polyps, hyperplasia, and carcinoma) in postmenopausal tamoxifen users (30). Cell culture studies have shown that tamoxifen agonist action is promoted by active Src and MAPKs in part through phosphorylation of ER␣ and its associated coregulators (31,32).…”

Tamoxifen Therapy for Breast Cancer and Endometrial Pathology

“…They recommended annual follow up of patients on tamoxifen. Cohen et al showed that 28.6% of patients on tamoxifen had endometrial pathology [6]. The incidence was significantly more in symptomatic patients.…”

The effects of tamoxifen on proliferation and steroid receptor expression in postmenopausal endometrium

“…[2][3][4][5][6][7] In postmenopausal women tamoxifen exerts a proliferative effect on the endometrium, as measured by the hyperdiploid fraction, 8 and clinical studies have reported an increased incidence of endometrial polyps and hyperplastic endometrial changes, mostly interpreted as evidence of the agonistic effect of tamoxifen. [9][10][11][12][13][14] Histology of tamoxifen exposed postmenopausal endometrium in general shows a characteristic picture of a condensated, hypercellular, collagen rich stroma, whereas the glandular epithelium stays thin and atrophic or metaplastic, the flattened epithelium lining cystically dilated glands or polyps. 8 13 15 The incidence of benign, tamoxifen induced changes by far exceeds the incidence of endometrial cancer, 14 suggesting that most of these endometrial changes do not progress to cancer.…”

“…[9][10][11][12][13][14] Histology of tamoxifen exposed postmenopausal endometrium in general shows a characteristic picture of a condensated, hypercellular, collagen rich stroma, whereas the glandular epithelium stays thin and atrophic or metaplastic, the flattened epithelium lining cystically dilated glands or polyps. 8 13 15 The incidence of benign, tamoxifen induced changes by far exceeds the incidence of endometrial cancer, 14 suggesting that most of these endometrial changes do not progress to cancer. Endometrial surveillance with transvaginal ultrasonography, as suggested by many clinicians, offers a high false positive rate in tamoxifen users, and is not warranted in asymptomatic women.…”