Long-term “protective” effect of aromatase inhibitors on the endometrium of postmenopausal breast cancer patients

Markovitch, Ofer; Tepper, R.; Fishman, A.; Aviram, R.; Cohen, Ilan

doi:10.1007/s10549-008-9941-4

Cited by 11 publications

(4 citation statements)

References 20 publications

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“…In a meta‐analysis of 5 sequenced therapy trials, the risk of endometrial cancer was substantially lower in women who were sequenced to receive aromatase inhibitors compared with those who continued on tamoxifen (odds ratio, 0.31; P = .007) . In terms of potential mediating mechanisms, a prospective clinical study indicated that long‐term aromatase inhibitor use reversed endometrial thickening associated with tamoxifen …”

Section: Discussionmentioning

confidence: 99%

“…18 In terms of potential mediating mechanisms, a prospective clinical study indicated that long-term aromatase inhibitor use reversed endometrial thickening associated with tamoxifen. 25 Limited numbers of randomized, placebocontrolled clinical trials have reported the influence of aromatase inhibitors on endometrial cancer in the settings of adjuvant breast cancer 26 and chemoprevention. 13,14 Results from those trials are provided in Table 5.…”

Section: Discussionmentioning

confidence: 99%

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Aromatase inhibitors, tamoxifen, and endometrial cancer in breast cancer survivors

Chlebowski

Schottinger

Shi

et al. 2015

Cancer

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Background Both endometrial cancer and postmenopausal breast cancer risk are increased by obesity and higher endogenous estrogen levels. While aromatase inhibitors reduce breast cancer incidence, their influence on endometrial cancer is uncertain. Methods We addressed this issue in a cohort of 17,064 women diagnosed with hormone receptor positive breast cancer in an integrated group practice health plan. Information on demographics, comorbidities and adjuvant endocrine therapy use was available from electronic medical and pharmacy records, respectively. Endometrial cancer information was obtained from the health plan’s SEER-affiliated tumor registry and rates were compared across endocrine therapy groups (aromatase inhibitor [n=5,303], tamoxifen [n=5155], switchers [both n=3787] or none [n=2819] using multi-variable adjusted Cox proportional hazard models. Results Endometrial cancer incidence was a statistically significant, 48% lower in the aromatase inhibitor versus tamoxifen group (HR 0.52, 95% CI 0.31–0.87, P=0.01). Endometrial cancer incidence was 29% lower in the aromatase inhibitor versus no endocrine therapy group (HR 0.71, 95% CI 0.37–1.35, P=0.30) and was 33% lower in the aromatase inhibitor versus tamoxifen group (HR 0.67, 95% CI 0.42–1.06, P=0.08), but neither difference was statistically significant. Associations were stronger among those with good drug adherence. Conclusions In a community based, integrated health plan setting, endometrial cancer incidence was lower in women on aromatase inhibitor compared to tamoxifen. Additionally, aromatase inhibitors may mitigate tamoxifen-associated endometrial cancer incidence. While there were somewhat fewer endometrial cancers in aromatase inhibitor versus no endocrine therapy users, further studies are needed for definitive assessment of this potential association.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Aromatase inhibitors, tamoxifen, and endometrial cancer in breast cancer survivors

Chlebowski

Schottinger

Shi

et al. 2015

Cancer

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“…Some research supports the association between tamoxifen and endometrial pathology of possible neoplastic potential. Currently, non‐steroidal aromatase inhibitors, which do not stimulate the endometrium and reverse tamoxifen‐induced uterine changes in postmenopausal breast cancer patients, are increasingly being used in the management of breast cancer . Although non‐steroidal aromatase inhibitors are much more expensive, non‐steroidal aromatase inhibitors did not have efficacy in the treatment of breast cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, non-steroidal aromatase inhibitors, which do not stimulate the endometrium and reverse tamoxifen-induced uterine changes in postmenopausal breast cancer patients, are increasingly being used in the management of breast cancer. [4][5][6] Although non-steroidal aromatase inhibitors are much more expensive, non-steroidal aromatase inhibitors did not have efficacy in the treatment of breast cancer. Therefore, tamoxifen may still have a role in breast cancer patients diagnosed with estrogen receptor-positive breast cancer because of the different side-effect profiles of new agents.…”

Section: Discussionmentioning

confidence: 99%

Microwave endometrial ablation for endometrial protection in women with breast cancer on adjuvant tamoxifen

Zhu

Yang

2013

J of Obstet and Gynaecol

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Aim: The purpose of the current study was to determine the effectiveness of microwave endometrial ablation (MEA) in inhibiting the proliferative response of the endometrium in women with breast cancer who are treated with tamoxifen. Material and Methods:In the before-after study, we treated 31 postmenopausal patients who had received adjuvant tamoxifen for 1 year or more with MEA, the endometrial changes were compared before and after MEA. Results: After MEA, the thickness of the uterine lining was decreased significantly. No patient had recurrent endometrial polyps or abnormal vaginal bleeding during the follow-up period. Conclusion: MEA had a protective action against the uterine effects of tamoxifen for postmenopausal patients. MEA is a safe and effective minimally invasive treatment method for breast cancer patients treated with tamoxifen.

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Dysregulation of Aromatase in Breast, Endometrial, and Ovarian Cancers

Manna

Molehin

Ahmed

2016

Progress in Molecular Biology and Translational Science

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Long-term “protective” effect of aromatase inhibitors on the endometrium of postmenopausal breast cancer patients

Abstract: Reversal of endometrial thickening induced by long-term tamoxifen treatment in postmenopausal breast cancer patients is maintained throughout long-term aromatase inhibitor treatment.

Cited by 11 publications

References 20 publications

Aromatase inhibitors, tamoxifen, and endometrial cancer in breast cancer survivors

Aromatase inhibitors, tamoxifen, and endometrial cancer in breast cancer survivors

Microwave endometrial ablation for endometrial protection in women with breast cancer on adjuvant tamoxifen

Dysregulation of Aromatase in Breast, Endometrial, and Ovarian Cancers

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