| Objective:For female breast cancer patients with progesterone receptor positive, Postoperative oral tamoxifen can significantly improve the prognosis of patients, meanwhile, it can lead to related gynaecology complications at the same time, such as endometrial lesions.recently, more and more literatures mentioned the use of Mirena in breast cancer treated with tamoxifen, which has preventive and therapeutic effects of endometrial lesions. In this paper, we discuss the protective actions with the prophylactic use of levonorgestrel intrauterine system (LNG-IUS) in breast cancer patients taking tamoxifen.Methods:We systematically searched PUBMED, EMBASE, Cochrane library and CNKI (Chinese National Knowledge Infrastructure) to collect relevant studies published from when the database were created to February 2014. Studies quality was assessed by Modified Jadad Score. The effective size was estimateed by relative risk (RR), mean difference (MD) and corresponding 95% confidence interval (95%CI). Meta-analysis was conducted with Review Manager Software 5.0.Results:Five randomized controlled trials (RCTs) contained 486 cases wer e included in the final analysis.analysis indicated:(1) Theincidence rate of endometrial polyps in 1 year group and above 1 year group with prophylactic levonorgestrel-releasing intrauter ine system is much lower than control group,(RR=0.14,95% CI:0.0 4-0.46,P<0.05; OR=0.25,95% CI:0.12-0.50,P<0.05);(2) The incidence rate of submucosal myomas in 1 year with pro phylactic levonorgestrel-releasing intrauterine system is much lower th an control group(RR=0.29,95% CI:0.10-0.85,P<0.05),but the incide nee rate in above 1 year group has no significant statistical differenc e with the control group(OR=0.43,95% CI:0.08-2.17, P>0.05).(3) The incidence rate of endometrial proliferation or secretory ch anges in 1 year with prophylactic levonorgestrel-releasing intrauterine systemis much lower than control group (RR=0.06,95% CI:0.01-0. 32,P<0.05),but the incidence rate in above 1 year group has no sign ificant statistical difference with the control group(RR=0.37,95% CI: 0.14-1.03, P>0.05).(4) The incidence rate of endometrial simple hyperplasia in 1 yea r group and above 1 year group with prophylactic levonorgestrel-relea sing intrauterine system has no significant statistical difference with t he control group (RR=0.34,95% CI:0.04-3.18,P>0.05; RR=0.21,95% CI:0.04-1.19, P>0.05)(5) The incidence rate of decidual change in endometrium in 1 y ear group and above 1 year group with prophylactic levonorgestrel-rel easing intrauterine system is much higher than control group (RR=38. 96,95% CI:12.60-120.48, P<0.05; RR=70.14,95% CI:14.21-346.16, P<0.05)(6) The endometrial thickness in 1 year with prophylactic levonor gestrel-releasing intrauterine system is much lower than control group, and has statistically significant difference(MD=-0.95,95% CI:-1.61- -0.28, P<0.05),but endometrial thickness in above 1 year group has no significant statistical difference with the control group (MD=-0.17, 95% CI:-0.88-0.53, P>0.05)(7) The incidence rate of vaginal bleeding in 6 month with prop hylactic levonorgestrel-releasing intrauterine system is much higher tha n control group (RR=3.90,95% CI:2.21-6.87, P<0.05), but the in cidence rate of vaginal bleeding in 1 year has no significant statistica 1 difference with the control group(RR=2.02,95% CI:0.90-4.51, P> 0.05)Conclusion:(1) Prophylactic use of Mirena has certain protective effect on benign endometrial lesion in breast cancer patients taking Tamoxifen,which could reduce the incidence rate of endometrial polyps obviously, and a charcateristic decidual change is common found in paitents with Mirena.(2) The incidence rate of endometrial carcinoma may not increase after use of Tamoxifen in breast cancer patients, there is no one endometrial carcinoma found in five RCTs. (3) The only significant adverse effect of the intrauterine system reported was an excess of vaginal bleeding in 1 year. |
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