The Endometrial Thickness changes in Tamoxifen-Treated postmenopausal women with breast Ca in Basrah.
Abstract
Background: Tamoxifen is widely used to treat breast carcinoma in postmenopausal women. Previous studies have suggested an increased prevalence of endometrial carcinoma and polyps after treatment with tamoxifen. Objective: This study was performed to evaluate pelvic sonographic measurement of endometrial thickness in postmenopausal breast cancer patients being treated with tamoxifen during one year and after 2year of treatment and its accuracy. Patients and method: Pelvic ultrasounds and medical records were reviewed for 48 postmenopausal women with breast carcinoma who were being treated with 20mg of tamoxifen. They were divided into two groups first group (28 patients)of at minimum 6 month and maximum 1 year treatment and second group (20 patients) of 2 years at minimum treatment with tamoxifen. Endometrial thickness was measured in anteroposterior dimension and was considered normal when less than 6 mm. Results: pelvic sonograms of all 48 patients showed that 25(52%) of women with normal endometrial thickness measuring less than 6mm in the two groups with 18 (64.3%) in first group and 7(35%) in second group and abnormal endometrial thickening measuring more than 6 mm in the two groups about 23 patients (48%) with 10(35.7%) in first group and 13 (65%) in second group in which the sonographic appearance of the endometrium included cystic lesion in 2 patient(15.4%) and 11 patient (84.6%) without cystic lesion. Conclusion: Only pelvic ultrasounds were done for endometrial evalution and the late complication are increased because of poor investigations being done to those patients in Basrah with breast carcinoma. A positive pelvic ultrasound result is of little value, so further testing is mandatory in order to detect benign and malignant endometrial disease associated with tamoxifen.References
Varras M, Polyzos D, Akrivis Ch. Effects of tamoxifen on the human female genital tract: review of the literature. Eur J Gynaecol Oncol. 2003;24(3-4):258-68.
Early Breast Cancer Trialists’ Collaborative Group (1998) Tamoxifen for early breast cancer: an overview of the randomised trials. Lancet 351: 1451–1467
Cohen I, Altaras MM, Lew S, Tepper R, Beyth Y and Ben-Baruch G. Ovarian endometrioid carcinoma and endometriosis developing in a postmenopausal breast cancer patient during tamoxifen therapy: A case report and review of the literature. Gynecol Oncol (1994) 55: 443–447
Barakat RR. Tamoxifen and endometrial neoplasia. Clin Obstet Gynecol(1996) 39: 629–640
Kedar RP, Bourne TH, Powles TJ, et al. Effects of tamoxifen on uterus and ovaries of postmenopausal women in a randomized breast cancer prevention trial. Lancet 1994;343:1318–1321.
Lucy E. Hann, Elissa M. Gretz, Ariadne M. Bach, Sonia M. Francis. Sonohysterography for Evaluation of the Endometrium in Women Treated with Tamoxifen. AJR: 2001;177:337-342.
Bree RL. Ultrasound of the endometrium: facts,controversies, and future trends.Abdom Imaging 1997;22:557–569
Hann LE, Giess CS, Bach AM, et,al. Endometrial thickness in tamoxifen-treated patients: correlation with clinical and pathologic findings .American Journal of Roentgenology, 1997. 168, 657-661,
Strauss HG, Wolters M, Methfessel G, Buchmann J, Koelbl H. Significance of endovaginal ultrasonography in assessing tamoxifen-associated changes of the endometrium. A prospective study. Acta Obstet Gynecol Scand 2000;79(8):697-701.
Davidson KG, Dubinsky TJ. Ultrasonographic evaluation of the endometrium in postmenopausal vaginal bleeding. Radiol Clin North Am. 2003;41(4):769-80.
Goldstein SR. Nachtigall M, Snyder JR, Nachtigall L. Endometrial assessment by vaginal ultrasonography before endometrial sampling in patients with postmenopausal bleeding. Am J Obstet Gynecol 1990;163:
Hulka CA and Hall DA. Endometrial abnormalities associated with tamoxifen therapy for breast cancer: sonographic and pathologic correlation. American Journal of Roentgenology, 1993: 160, 809-812,
Varras M, Polyzos D, Akrivis Ch. Effects of tamoxifen on the human female genital tract: review of the literature.Eur J Gynaecol Oncol. 2003;24(3-4):258-68.
Juneja M, Jose R, Kekre AN, Viswanathan F, Seshadri L. Tamoxifen-induced endometrial changes in postmenopausal women with breast carcinoma. Int J Gynaecol Obstet 2002;76:279-84.
Fishman M, Boda M, Sheiner E, Rotmensch J, Abramowicz J. Changes in the sonographic appearance of the uterus after discontinuation of tamoxifen therapy. J Ultrasound Med. 2006;25(4):469-73
Weaver J, McHugo J M, and Clark T J, Accuracy of transvaginal ultrasound in diagnosing endometrial pathology in women with post-menopausal bleeding on tamoxifen. British Journal of Radiology .2005; 78:394-397
Lin MC, Gosink BB, Wolf SI, Feldesman MR, Stuenkel CA, Braly PS, Pretorius DH. Endometrial thickness after menopause: effect of hormone replacement. Radiology. 1991;180(2):427-32.
- Fung MF, Reid A, Faught W, Le T, Chenier C, Verma S, et al. Prospective longitudinal study of ultrasound screening for endometrial abnormalities in women with breast cancer receiving tamoxifen. Gynecol Oncol 2003;91:154–9.
MB Marttunen, B Cacciatore, P Hietanen, S Pyrhönen, A Tiitinen, T Wahlström and O Ylikorkala. Prospective study on gynaecological effects of two antioestrogens tamoxifen and toremifene in postmenopausal women. British Journal of Cancer 2001: 84(7), 897–902
