Obstet Gynecol Sci.  2017 Jan;60(1):26-31. 10.5468/ogs.2017.60.1.26.

Endometrial polyp surveillance in premenopausal breast cancer patients using tamoxifen

• Jeon SJ
• Lee JI
• Lee M
• Kim HS
• Kim JW
• Park NH
• Song YS

• KMID: 2383204
• DOI: http://doi.org/10.5468/ogs.2017.60.1.26

Abstract

OBJECTIVE
To describe the endometrial pathologic lesions in premenopausal breast cancer patients with a history of tamoxifen (TMX) use.
METHODS
We retrospectively reviewed the medical records of 120 premenopausal breast cancer patients with a history of TMX use that had undergone a gynecological examination.
RESULTS
Among 120 patients, 44.2% (n=53) were asymptomatic with an endometrial thickness ≥5 mm, as assessed by transvaginal ultrasonography. Of the patients that reported abnormal uterine bleeding, 5% (n=6) had an endometrial thickness <5 mm and 20% (n=24) had an endometrial thickness ≥5 mm by transvaginal ultrasonography. The final group of patients were asymptomatic, but showed an abnormal endometrial lesion, such as an endometrial polyp, by transvaginal ultrasonography (30.8%, n=37). Of the 56 benign lesions that were histologically reviewed, 50 (41.7%) were endometrial polyps, 3 (2.5%) were submucosal myomas, 2 (1.7%) were endometrial hyperplasias, and 1 (0.8%) was chronic endometritis. There were 64 (53.3%) other non-pathologic conditions, including secreting, proliferative, and atrophic endometrium, or in some cases, there was insufficient material for diagnosis. In our data, only one case was reported as a complex hyperplasia without atypia arising from an endometrial polyp, and one patient was diagnosed with endometrioid adenocarcinoma.
CONCLUSION
For premenopausal breast cancer patients with a history of TMX use, the majority of the patients were asymptomatic, and endometrial polyps were the most common endometrial pathology observed. Therefore, we believe that endometrial assessment before starting TMX treatment, and regular endometrial screening throughout TMX treatment, are reasonable suggestions for premenopausal breast cancer patients.

Keyword

Breast neoplasms; Endometrial polyps; Hysteroscopy; Premenopausal; Tamoxifen

MeSH Terms

Breast Neoplasms*
Breast*
Carcinoma, Endometrioid
Diagnosis
Endometrial Hyperplasia
Endometritis
Endometrium
Female
Gynecological Examination
Humans
Hyperplasia
Hysteroscopy
Mass Screening
Medical Records
Myoma
Pathology
Polyps*
Retrospective Studies
Tamoxifen*
Ultrasonography
Uterine Hemorrhage
Tamoxifen

Reference

1. Kim Z, Min SY, Yoon CS, Jung KW, Ko BS, Kang E, et al. The basic facts of Korean breast cancer in 2012: results from a nationwide survey and breast cancer registry database. J Breast Cancer. 2015; 18:103–111.

2. Figg WD 2nd, Cook K, Clarke R. Aromatase inhibitor plus ovarian suppression as adjuvant therapy in premenopausal women with breast cancer. Cancer Biol Ther. 2014; 15:1586–1587.

3. Le Donne M, Alibrandi A, Ciancimino L, Azzerboni A, Chiofalo B, Triolo O. Endometrial pathology in breast cancer patients: Effect of different treatments on ultrasonographic, hysteroscopic and histological findings. Oncol Lett. 2013; 5:1305–1310.

4. Davies C, Pan H, Godwin J, Gray R, Arriagada R, Raina V, et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet. 2013; 381:805–816.

5. Goss PE. Preventing relapse beyond 5 years: the MA.17 extended adjuvant trial. Semin Oncol. 2006; 33:2 Suppl 7. S8–S12.

6. Sismondi P, Biglia N, Volpi E, Giai M, de Grandis T. Tamoxifen and endometrial cancer. Ann N Y Acad Sci. 1994; 734:310–321.

7. Cohen I, Altaras MM, Shapira J, Tepper R, Rosen DJ, Cordoba M, et al. Time-dependent effect of tamoxifen therapy on endometrial pathology in asymptomatic postmenopausal breast cancer patients. Int J Gynecol Pathol. 1996; 15:152–157.

8. Cheng WF, Lin HH, Torng PL, Huang SC. Comparison of endometrial changes among symptomatic tamoxifen-treated and nontreated premenopausal and postmenopausal breast cancer patients. Gynecol Oncol. 1997; 66:233–237.

9. Saccardi C, Gizzo S, Patrelli TS, Ancona E, Anis O, Di Gangi S, et al. Endometrial surveillance in tamoxifen users: role, timing and accuracy of hysteroscopic investigation. Observational longitudinal cohort study. Endocr Relat Cancer. 2013; 20:455–462.

10. Berliere M, Charles A, Galant C, Donnez J. Uterine side effects of tamoxifen: a need for systematic pretreatment screening. Obstet Gynecol. 1998; 91:40–44.

11. Deligdisch L, Kalir T, Cohen CJ, de Latour M, Le Bouedec G, Penault-Llorca F. Endometrial histopathology in 700 patients treated with tamoxifen for breast cancer. Gynecol Oncol. 2000; 78:181–186.

12. Ramondetta LM, Sherwood JB, Dunton CJ, Palazzo JP. Endometrial cancer in polyps associated with tamoxifen use. Am J Obstet Gynecol. 1999; 180(2 Pt 1):340–341.

13. Cohen I, Bernheim J, Azaria R, Tepper R, Sharony R, Beyth Y. Malignant endometrial polyps in postmenopausal breast cancer tamoxifen-treated patients. Gynecol Oncol. 1999; 75:136–141.

14. Costa-Paiva L, Godoy CE Jr, Antunes A Jr, Caseiro JD, Arthuso M, Pinto-Neto AM. Risk of malignancy in endometrial polyps in premenopausal and postmenopausal women according to clinicopathologic characteristics. Menopause. 2011; 18:1278–1282.

15. Cohen I. Endometrial pathologies associated with postmenopausal tamoxifen treatment. Gynecol Oncol. 2004; 94:256–266.

16. Committee Opinion No. 601: Tamoxifen and uterine cancer. Obstet Gynecol. 2014; 123:1394–1397.

17. Ismail SM. Pathology of endometrium treated with tamoxifen. J Clin Pathol. 1994; 47:827–833.

18. Hoogendoorn WE, Hollema H, van Boven HH, Bergman E, de Leeuw-Mantel G, Platteel I, et al. Prognosis of uterine corpus cancer after tamoxifen treatment for breast cancer. Breast Cancer Res Treat. 2008; 112:99–108.

19. Le Donne M, Lentini M, De Meo L, Benedetto V, Mesiti M. Uterine pathologies in patients undergoing tamoxifen therapy for breast cancer: ultrasonographic, hysteroscopic and histological findings. Eur J Gynaecol Oncol. 2005; 26:623–626.

20. Buijs C, Willemse PH, de Vries EG, Ten Hoor KA, Boezen HM, Hollema H, et al. Effect of tamoxifen on the endometrium and the menstrual cycle of premenopausal breast cancer patients. Int J Gynecol Cancer. 2009; 19:677–681.