Breast Cancer Research and Treatment

, Volume 26, Issue 1, pp 101–105 | Cite as

The effect of tamoxifen on the endometrium

  • Beatrice Uziely
  • Abi Lewin
  • George Brufman
  • Dan Dorembus
  • Shlomo Mor-Yosef
Brief communication

Summary

Tamoxifen is one of the most important treatments for breast cancer, especially in postmenopausal patients. It acts primarily as an anti-estrogenic agent, due to its cytoplasmic estrogen receptor binding capacity. However, it also exerts a mild estrogenic effect. Since the prolonged use of estrogen has been reported to increase the rate of benign and malignant changes in the endometrium, we evaluated whether there is a correlation between tamoxifen therapy and endometrial benign and malignant conditions. The study group comprised 95 patients with breast cancer who were treated with tamoxifen. No control group was examined. Patients underwent vaginal ultrasonography and endometrial biopsy in order to evaluate any changes in the endometrium occurring during tamoxifen therapy. Pathological changes were observed in 14 patients, 13 of whom were treated with tamoxifen for more than 12 months. Of these women, 3 were diagnosed with endometrial cancer, 3 had mild dysplasia, 3 had endometrial hyperplasia, and 4 had a benign endometrial polyp. Our findings indicate a significant correlation between long-term tamoxifen administration and endometrial proliferation. We therefore recommend that women treated with tamoxifen for more than 12 months have an annual vaginal ultrasonography and endometrial biopsy.

Key words

breast cancer endometrium tamoxifen ultrasound 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Sunderland MC, Osborne CK: Tamoxifen in premenopausal patients with metastatic breast cancer: a review. J Clin Oncol 9: 1283–1297, 1991Google Scholar
  2. 2.
    Goldhirsch A, Gelber RD, Castiglione M, for the International Breast Cancer Study Group: Adjuvant therapy of breast cancer. Eur J Cancer 27: 399–402, 1991Google Scholar
  3. 3.
    Ziegler LD, Buzdar AU: Current status of adjuvant therapy of early breast cancer. Am J Clin Oncol 14: 101–110, 1991Google Scholar
  4. 4.
    Powles TJ, Tillyer CR, Jones AL: Prevention of breast cancer with tamoxifen - an update on the Royal Marsden Hospital Pilot Programme. Eur J Cancer 26: 680–684, 1990Google Scholar
  5. 5.
    Bornstein L, Ross RK, Henderson BE: Prospects for the primary prevention of breast cancer. Am J Epidemiol 135: 142–152, 1991Google Scholar
  6. 6.
    Spinelli G, Bardozzi N, Citernessi A, Fontonarosa M, Curiel P: Endometrial carcinoma in tamoxifen treated cancer patients. J Chemother 3: 267–270, 1991Google Scholar
  7. 7.
    Jordan VC: Long-term adjuvant tamoxifen therapy for breast cancer. Breast Cancer Res Treat 15: 125–136, 1990Google Scholar
  8. 8.
    Buckley CH: Tamoxifen and endometriosis. Case report. J Obstet Gynecol 97: 645–646, 1990Google Scholar
  9. 9.
    Nuovo MA, Nuovo GY, McCaffrey RM, Levin RU, Barron B, Winkler B: Endometrial polyps in postmenopausal patients receiving tamoxifen. Int J Gynecol Pathol 8: 125–131, 1983Google Scholar
  10. 10.
    Cross SS, Ismail S: Endometrial hyperplasia in an oophorectomized woman receiving tamoxifen therapy. Case report. Br J Obstet Gynecol 97: 551–552, 1990Google Scholar
  11. 11.
    Corly D, Rowe J, Curtis MT, Hogon WN, Noumoff JS, Livolsi WA: Postmenopausal bleeding from unusual endometrial polyps in women on chronic tamoxifen therapy. Obstet Gynecol 79: 111–116, 1992Google Scholar
  12. 12.
    Mathew A, Chabon AB, Kabakow B, Drucker M, Hirshman RJ: Endometrial carcinoma in five patients with breast cancer on tamoxifen therapy. NY State J Med 90: 207–208, 1990Google Scholar
  13. 13.
    Malfetano JH: Tamoxifen-associated endometrial carcinoma in postmenopausal breast cancer patients. Gynecol Oncol 39: 82–84, 1990Google Scholar
  14. 14.
    Gusberg SB: Tamoxifen for breast cancer: associated endometrial cancer. Cancer 65: 1463–1464, 1990Google Scholar
  15. 15.
    Anzai Y, Holinka CF, Kuramoto H, Gurpide E: Stimulatory effects of 4-hydroxytamoxifen on proliferation of human endometrial adenocarcinoma cells (Ishikawa Line). Cancer Res 49: 2362–2365, 1989Google Scholar
  16. 16.
    Early Breast Cancer Trialists' Collaborative Group: Systemic treatment of early breast cancer by hormonal, cytotoxic, or immune therapy. 132 randomised trials involving 31,000 recurrences and 24,000 deaths among 75,000 women. Lancet 339: 1–15 & 71-85, 1992Google Scholar
  17. 17.
    Fornander T, Cedermark B, Mattsson A: Adjuvant tamoxifen in early breast cancer: occurrence of new primary cancers. Lancet i: 117–120, 1989Google Scholar
  18. 18.
    Hardell L: Tamoxifen as risk factor for carcinoma of corpus uteri (letter). Lancet ii: 563, 1988Google Scholar
  19. 19.
    Hardell L: Pelvic irradiation and tamoxifen as risk factors for carcinoma of corpus uteri (letter). Lancet ii: 1432, 1988Google Scholar
  20. 20.
    Satyaswaroop PG, Zaino RJ, Mortel R: Estrogen-like effects of tamoxifen on human endometrial carcinoma transplanted into nude mice. Cancer Res 44: 4006–4009, 1984Google Scholar
  21. 21.
    Granberg S, Wikland M, Karlsson B, Norstrom A, Friberg LG: Endometrial thickness as measured by endovaginal ultrasonography for identifying endometrial abnormalilty. Am J Obstet Gynecol 164: 47–52, 1991Google Scholar
  22. 22.
    Nasri MN, Coast GJ: Correlation of ultrasound findings and endometrial histopathology in postmenopausal women. Br J Obstet Gynecol 96: 1333–1338, 1989Google Scholar
  23. 23.
    Dilts PV Jr, Hopkins MP, Chang AE, Cody RL: Rapid growth of leiomyoma in patients receiving tamoxifen. Am J Obstet Gynecol 166: 167–168, 1992Google Scholar
  24. 24.
    Ewertz M, Storm HH: Multiple primary cancers of the breast, endometrium and ovary. Eur J Cancer Clin Oncol 25: 1927–1932, 1989Google Scholar
  25. 25.
    State of Israel Ministry of Health, Department of Epidemiology, Israel Cancer Registry: Cancer in Israel - facts and figures 70: 1977–1981, 1987Google Scholar
  26. 26.
    Adami HO, Krusemo UB, Bergkvist L, Persson I, Pettersson B: On the age-dependent association between cancer of the breast and of the endometrium. A nationwide cohort study. Br J Cancer 55: 77–80, 1987Google Scholar

Copyright information

© Kluwer Academic Publishers 1993

Authors and Affiliations

  • Beatrice Uziely
    • 1
  • Abi Lewin
    • 2
  • George Brufman
    • 1
  • Dan Dorembus
    • 2
  • Shlomo Mor-Yosef
    • 2
  1. 1.Sharett Institute of OncologyHadassah University HospitalJerusalemIsrael
  2. 2.Department of Obstetrics and GynecologyHadassah University HospitalJerusalemIsrael

Personalised recommendations