Effect of adjuvant tamoxifen on the endometrium in women with breast cancer: A prospective study using office endometrial biopsy Journal Article

Authors: Barakat, R. R.; Gilewski, T. A.; Almadrones, L.; Saigo, P. E.; Venkatraman, E.; Hudis, C.; Hoskins, W. J.
Article Title: Effect of adjuvant tamoxifen on the endometrium in women with breast cancer: A prospective study using office endometrial biopsy
Abstract: Purpose: To determine the frequency of developing abnormal pathologic changes in the endometria of tamoxifen-treated women. To characterize the type of pathologic changes involved. Patients and Methods: Between October 1991 and September 1998, 159 patients initiating tamoxifen therapy for breast cancer confined to the breast and axillary lymph nodes were entered in a prospective study. In this study, office endometrial biopsies (EMBs) were obtained during the initiation of tamoxifen and at 6-month intervals for a 2-year period. Three subsequent annual EMBs were recorded for each patient, amounting to a 5-year surveillance. Results. One hundred fifty-nine patients with a median age of 50 years were entered onto study. Patients were assessable if EMBs were performed at least 1 year after the initiation of tamoxifen treatment. Nine patients (5.7%) were considered protocol violations. The remaining 111 assessable patients underwent a total of 635 EMBs (mean, 5.8 EMBs), with a median surveillance time of 36 months. Eighty-two (12.9%) of the 635 biopsies revealed tissue insufficient for diagnosis. Fourteen patients (12.6%) underwent dilation and curettage (DandC) for an abnormal EMB, persistent bleeding, or for evaluation of adnexal masses at the time of laparoscopy. Findings at DandC included complex hyperplasia (n = 1), abnormal histiocytes (n = 1), simple hyperplasia (n = 2), polyps (n = 4), endocervical polyp (n = 1), and decidualization (n = 2). Three DandCs were negative. Three patients have undergone hysterectomy. Conclusion: EMB was used to monitor the endometrium in the majority (95%) of breast cancer patients on tamoxifen in this trial, but the utility of routine EMB for screening in tamoxifen-treated women seems limited. (C) 2000 by American Society of Clinical Oncology.
Keywords: adult; controlled study; human tissue; aged; middle aged; human cell; major clinical study; clinical trial; histopathology; cancer adjuvant therapy; chemotherapy, adjuvant; hysterectomy; endometrial neoplasms; endometrium cancer; prospective studies; controlled clinical trial; breast cancer; randomized controlled trial; cancer screening; breast neoplasms; biopsy; drug surveillance program; diagnostic value; tamoxifen; neoplasms, second primary; antineoplastic agents, hormonal; endometrium; endometrium biopsy; estrogen receptor modulators; humans; human; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 18
Issue: 20
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2000-10-20
Start Page: 3459
End Page: 3463
Language: English
PUBMED: 11032585
PROVIDER: scopus
Notes: Export Date: 18 November 2015 -- Source: Scopus