Evaluation of endometrial abnormalities in breast cancer patients on tamoxifen therapy

Silvia Hossain; Begum Rokeya Anwar; Foujia Sharmin; Ayesha Siddiqua; M. Saklayen Hossain

doi:10.18203/2320-1770.ijrcog20253063

Authors

Silvia Hossain Department of Gynaecological Oncology, National Institute of Cancer Research & Hospital, Dhaka, Bangladesh
Begum Rokeya Anwar Department of Gynaecological Oncology, National Institute of Cancer Research & Hospital, Dhaka, Bangladesh
Foujia Sharmin Shaheed Suhrawardy Medical College & Hospital, Dhaka, Bangladesh
Ayesha Siddiqua National Institute of Cancer Research & Hospital, Dhaka, Bangladesh
M. Saklayen Hossain National Institute of Traumatology & Orthopaedic Rehabilitation, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20253063

Keywords:

TVS, Atypia, Endometrium, Hyperplasia, Tamoxifen

Abstract

Background: Breast cancer is the most common malignancy in women. Tamoxifen, widely used as adjuvant therapy, has anti-estrogenic effects on breast tissue but may induce endometrial changes due to estrogenic stimulation. To evaluate endometrial abnormalities in postmenopausal breast cancer patients receiving tamoxifen therapy.

Methods: This cross-sectional study was conducted at the Department of Gynaecological Oncology, NICRH, Dhaka, over one year. Seventy-five postmenopausal breast cancer patients who had received tamoxifen for more than six months were enrolled. All underwent transvaginal ultrasound (TVS) and 32 patients subsequently had histopathological evaluation. Data were analyzed using SPSS v23.

Results: The mean age was 58.03±7.96 years. TVS revealed endometrial thickness of 4–7.9 mm in 58.6%, 8–11.9 mm in 8%, 12–15.9 mm in 12%, 16–19.9 mm in 6.7% and ≥20 mm in 14.6% of patients, with a mean thickness of 11.22±6.68 mm. Thickness ≥8 mm was significantly associated with longer tamoxifen use (p<0.05). Histopathology (n=32) showed 25% normal endometrium, while 75% had abnormalities: polyps (28.1%), hyperplasia without atypia (25%), hyperplasia with atypia (9.4%), atrophy (9.4%) and carcinoma (3.1%). A significant correlation was found between TVS findings and histopathology (p=0.044).

Conclusions: Nearly two-fifths of patients developed endometrial thickening >8 mm and three-quarters of those biopsied had abnormal histopathology, including hyperplasia with atypia and carcinoma. Long-term tamoxifen therapy in postmenopausal women may predispose to endometrial pathology, warranting regular surveillance with TVS and prompt biopsy for suspicious cases.

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References

Waks AG, Winer EP. Breast Cancer Treatment: A Review. JAMA. 2019;321(3):288–300. DOI: https://doi.org/10.1001/jama.2018.19323

GBD 2017 Stomach Cancer Collaborators. The global, regional, and national burden of stomach cancer in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease study 2017. Gastroenterol Hepatol. 2019;5(1):42.

Oseni T, Patel R, Pyle J, Jordan VC. Selective estrogen receptor modulators and phytoestrogens. Planta Med. 2008;74(13):1656–65. DOI: https://doi.org/10.1055/s-0028-1088304

Fornander T, Rutqvist LE, Cedermark B, Glas U, Mattsson A, Skoog L, et al. Adjuvant tamoxifen in early-stage breast cancer: effects on intercurrent morbidity and mortality. J Clin Oncol. 1991;9(10):1740–8. DOI: https://doi.org/10.1200/JCO.1991.9.10.1740

Kochar S, Arora P, Chattopadhyay AB. Tamoxifen Therapy for Breast Cancer and Endometrial Pathology. Med J, Armed Forces India. 2005;61(4):313–5.

Gonc MAG, Gonc WJ. Hysteroscopic evaluation of the endometrium of post-menopausal patients with breast cancer before and after tamoxifen use. Int J Gynecol Obstet 1999;273–9. DOI: https://doi.org/10.1016/S0020-7292(99)00079-X

Polin SA, Ascher SM. The effect of tamoxifen on the genital tract. Cancer Imaging. 2008;8(1):135–45. DOI: https://doi.org/10.1102/1470-7330.2008.0020

Lee S, Kim YH, Kim SC, Joo JK, Seo DS, Kim KH, et al. The effect of tamoxifen therapy on the endometrium and ovarian cyst formation in patients with breast cancer. Obstet Gynecol Sci. 2018;61(5):615–20. DOI: https://doi.org/10.5468/ogs.2018.61.5.615

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(4):1305–10. DOI: https://doi.org/10.3892/ol.2013.1156

Gerber B, Krause A, MÜller H, Reimer T, KÜlz T, Makovitzky J, et al. Effects of adjuvant tamoxifen on the endometrium in postmenopausal women with breast cancer: A prospective long-term study using transvaginal ultrasound. J Clin Oncol. 2000;18(20):3464–70. DOI: https://doi.org/10.1200/JCO.2000.18.20.3464

Rahman S, Salehin F, Iqbal A. Menopausal symptoms assessment among middle age women in Kushtia, Bangladesh. BMC Res Notes. 2011;4(1):188. DOI: https://doi.org/10.1186/1756-0500-4-188

Kaulagekar A. Age of menopause and menopausal symptoms among urban women in Pune, Maharashtra. J Obstet Gynecol India. 2011;61(3):323–6. DOI: https://doi.org/10.1007/s13224-011-0036-5

Byrne A, Hodge A, Jimenez-Soto E, Morgan A. Looking beyond supply: a systematic literature review of demand-side barriers to health service utilization in the mountains of Nepal. Asia Pacific Journal of Public Health. 2013;25(6):438-51. DOI: https://doi.org/10.1177/1010539513496139

Shanta Gyawali, Shankar Nand Subedi, Nawazia Yasmin SP. Health Care Seeking Practice for Menopausal Problems among Women in International Journal of Health Sciences and Research Health Care Seeking Practice for Menopausal Problems among Women in. Int J Heal Sci Res. 2016;11(8):0–7.

Cohen I, Perel E, Flex D, Tepper R, Altaras MM, Cordoba M, et al. Endometrial pathology in postmenopausal tamoxifen treatment: Comparison between gynaecologically symptomatic and asymptomatic breast cancer patients. J Clin Pathol. 1999;52(4):278–82. DOI: https://doi.org/10.1136/jcp.52.4.278

Teixeira AC, Urban LABD, Schwarz RS, Pereira C, Millani TCC, Passos AP. Value of sonographic endometrial findings in patients under tamoxifen therapy. Radiol Bras. 2007;40(6):365–9. DOI: https://doi.org/10.1590/S0100-39842007000600003

Ozşener S, Ozaran A, Itil I, Dikmen Y. Endometrial pathology of 104 postmenopausal breast cancer patients treated with tamoxifen. Eur J Gynaecol Oncol. 1998;19(6):580–3.

Cohen I, Altaras MM, Shapira J, Tepper R, Rosen DJD, 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(2):152–7. DOI: https://doi.org/10.1097/00004347-199604000-00010

Kochar SPS, Arora P, Chattopadhyay AB. Tamoxifen therapy for breast cancer and endometrial pathology. Med J Armed Forces India. 2005;61(4):313–5. DOI: https://doi.org/10.1016/S0377-1237(05)80052-8

Van Leeuwen FE, van den Belt-Dusebout AW, van Leeuwen FE, Benraadt J, Diepenhorst FW, van Tinteren H, et al. Risk of endometrial cancer after tamoxifen treatment of breast cancer. Lancet. 1994;343(8895):448–52. DOI: https://doi.org/10.1016/S0140-6736(94)92692-1

Sasco AJ, Chaplain G, Amoros E, Saez S. Endometrial Cancer following Breast Cancer. Epidemiology. 1996;7(1):9–13. DOI: https://doi.org/10.1097/00001648-199601000-00003

Bergman L, Beelen ML, Gallee MP, Hollema H, Benraadt J, van Leeuwen FE. Risk and prognosis of endometrial cancer after tamoxifen for breast cancer. Comprehensive Cancer Centres’ALERT Group. Lancet (London, England). 2000;356(9233):881–7. DOI: https://doi.org/10.1016/S0140-6736(00)02677-5