Endometrial abnormalities in breast cancer patients with tamoxifen therapy

Abstract

Objective Evaluation of the effect of tamoxifen therapy on endometrium in patients who have previously undergone surgery for breast cancer. Design An analysis of hysteroscopic findings and their correlation with those from previous vaginal ultrasonography and subsequent endometrial sampling. Setting The hysteroscopy unit of a university clinic. Subjects 64 patients referred from the breast clinic, who had previously undergone surgery for breast cancer and who were receiving adjuvant tamoxifen therapy, with either suspicious findings on routine vaginal ultrasonography or abnormal uterine bleeding. Of the patients, 22 were premenopausal (group A) and 42 postmenopausal (group B). Each group was divided in two subgroups, comprising either symptomatic patients (groups A1 and B1) or asymptomatic patients (groups A2 and B2). Intervention: Diagnostic hysteroscopy. Results All six patients of group A1 were found to have hyperplastic endometrium on hysteroscopy. Subsequent biopsy after dilation and curettage (D&C) revealed simple endometrial hyperplasia in all samples, plus endometrial polyps in two cases. Despite suspicious appearances on vaginal ultrasonography, all 16 asymptomatic premenopausal patients (group A2) were found on hysteroscopy to have normal endometrium. Among the 29 patients with postmenopausal uterine bleeding (group B1) 22 showed hyperplastic endometrial findings on hysteroscopy. The histopathological results from the subsequent D&C, confirmed the hysteroscopic findings, showing various degrees of endometrial hyperplasia and three adenocarcinomas (4.7% of the total number of patients or 10.3% of those with postmenopausal bleeding). Normal or atrophic endometrium was observed in nine of the 13 patients in group B2; there was one polyp, and three cases of hyperplastic endometrium, which were found to be simple hyperplasia on pathological investigation. Conclusions Monitoring of the uterine cavity in patients receiving tamoxifen therapy is mandatory, especially where there is postmenopausal bleeding. Hysteroscopy findings display a considerably higher degree of correlation with endometrial pathology results, than do vaginal ultrasonography findings.