| Background:Tamoxifen (TAM) is a kind of selective estrogen receptor modulator, which exhibit tissue-specific estrogen agonist and antagonist effects. In 1977 by the United States Food and Drugs Authority approved for treatment of women who have breast cancer. It is found that the TAM can contain women estrogen receptors-positive breast cancer. Now TAM as pre-menopausal and post-menopausal women treatment of breast cancer endocrine preferred drug without considering its phased factors. Due to the declining mortality rate that is partly attributable to the use of effective adjuvant therapy, more women survive their breast cancers. As the prevention to secondary breast cancer in high-risk patients, tamoxifen serves to increase their survival rate. However, TAM has estrogenic side effects in different tissue. One of these estrogen-like side effect results in endometrial proliferation together with the possibility of development of polyps, hyperplasia and a higher risk of endometrial cancer. We should give more attention to the patients who are using clinical applications in the area of gynecological side effects. There is no consensus whether TAM-treated cases should be counseled any diagnositic intervention. Doctor should evaluate endometrial abnormalities by ultrasonography, hysteroscopy and biopsy in asymptomatic breast cancer patients treated with tamoxifen as adjuvant therapy.Objective:To evaluate the effect of tamoxifen (TAM) on endometrium in postoperative breast cancer treated with TAM. To discuss the action of tamoxifen on endometrium and forecast the dangerous period of endometrial pathological changes which is induced by tamoxifen.Materials and method:This study was performed at Qilu hospital, department of gynecology from January 2004 to December 2010. By the method of retrospective analyzing, we reviewed the clinical histories of 69 patients. Mean age of patients was 50.07±9.76 (range 36～78). Divide all patients into two groups. One is named Group TAM in which patients are treated with tamoxifen after breast cancer operation, the other is named Group N-TAM in which patients are treated without taomoxifen after breast cancer operation. All patients record were evaluated for demographic and clinical features, for endometrial thickness measurements, as detected by transvaginal ultrasonography (TVS) studies, and for various endometrial pathologies detected. The endometrial thickness was measured in the sagittal plane. Group TAM has 50 cases, including 32 postmenopausal and 18 premenopausal. Non-TAM group has 19 cases, including 12 postmenopausal and 7 premenopausal. All patients have a full clinical data.All breast cancer patients with intact uterus who remain treated TAM including in the study. All patients were treated with 20mg TAM daily.Statistical analysis was performed using t-test and X2-test with repeated measures, with a value of P<0.05 considered as significant.Results:1. The main abnormalities for breast cancer patients coming to the department of gynecology is vaginal bleeding (19/69,27.5%) and disordered menstruation (7/69,10.1%), asymptomatic patients 40 cases (40/69,58.0%)2. Ultrasonography examination find:There was significant relation about mean endometrial thickness between group TAM (9.04±3.83mm) and group N-TAM (6.11±1.80mm) is found (P<0.05). There is significant relation about mean endometrial thickness with postmenopausal patients between group TAM (8.38±3.69mm) and group N-TAM (5.92±1.80mm) is found (P<0.05)3. As breast cancer patients treated with tamoxifen longer than 6months, there is significant relation about endometrial thickness between premenopausal and postmenopausal is found (P<0.05), and the incidence of endometrial polyps is increasing between time≤6months and time>12months, the significant relation is found (P<0.05)4. In our research,46.4%(32/69) breast cancer patients with tamoxifen-treated have hysteroscopy after finding endometrial thickening by ultrasonography. By hysteroscopy, group TAM has a higher incidence of endometrial polyps (23/35, 75.8%). The endometrial polyps have many different appearances.5. In group TAM, the incidence of endometrial polyps in premenopausal and postmenopausal patients is 22.2%(4/18) and 46.9%(15/32), respectively. There is significant relation between them (P<0.05). The endometrial pathologies appear:There is a significant relation between group TAM and group N-TAM about the incidence of endometrial polyps (P<0.05)Conclusion:1. Long-term administration tamoxifen may cause high rate of endometrial pathologies, including endometrial polyps and hyperplasia, and the incidence is higher in postmenopausal patients.2. Long-term tamoxifen therapy in breast cancer patients should accept ultrasonography and hysteroscopy to diagnosis endometrial pathologies. asymptomatic patients should hysteroscopy with biopsy after one year tamoxifen-treated in premenopausal patients, and six months in postmenopausal patients. |
PDF Full Text Request