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Uterine changes during tamoxifen, toremifene, and other therapy for breast cancer: evaluation with magnetic resonance imaging

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Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

We have performed pelvic magnetic resonance imaging (MRI) in patients undergoing breast cancer surgery before and after adjuvant drug therapy. Our purpose was to detect any radiographic uterine changes induced by various types of adjuvant therapy on pre- and postmenopausal patients by evaluating prospectively performed MRI.

Materials and methods

Between September 2004 and December 2007, a total of 41 women with breast cancer (11 premenopausal, 30 postmenopausal) were enrolled. All underwent MRI of the pelvis before and after drug therapy, and uterine changes were evaluated. Postoperative drugs used were selective estrogen receptor modulators (SERMs) including tamoxifen and toremifene (n = 18), aromatase inhibitors (n = 13), and anticancer drugs (n = 10).

Results

Only the postmenopausal patients receiving SERMs showed a significant increase in endometrial thickness: from 2.4 ± 0.4 mm before therapy to 4.5 ± 2.6 mm after therapy (P = 0.0485). No statistically significant endometrial change was evident in postmenopausal patients treated with aromatase inhibitors (P = 0.573) or anticancer drugs (P = 0.754). Also, in premenopausal patients treated with SERMs or anticancer drugs, the change in endometrial thickness was not statistically significant (P = 0.958, 0.370).

Conclusion

This prospective study using MRI has demonstrated that uterine changes associated with adjuvant drugs for breast cancer occur exclusively in postmenopausal patients receiving SERMs.

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References

  1. Utsumi T, Kobayashi N, Hanada H. Recent perspectives of endocrine therapy for breast cancer. Breast Cancer 2007;14:194–199.

    Article  PubMed  Google Scholar 

  2. Senkus-Konefka E, Konefka T, Jassem J. The effects of tamoxifen on the female genital tract. Cancer Treat Rev 2004;30:291–301.

    Article  CAS  PubMed  Google Scholar 

  3. Polin SA, Ascher SM. The effect of tamoxifen on the genital tract. Cancer Imaging 2008;8:135–145.

    Article  PubMed  Google Scholar 

  4. Varras M, Polyzos D, Akrivis C. Effects of tamoxifen on the human female genital tract: review of the literature. Eur J Gynaecol Oncol 2003;24:258–268.

    CAS  PubMed  Google Scholar 

  5. Marttunen MB, Cacciatore B, Hietanen P, Pyrhonen S, Tiitinen A, Wahlstrom T, et al. Prospective study on gynaecological effects of two antioestrogens tamoxifen and toremifene in postmenopausal woman. Br J Cancer 2001;84:897–902.

    Article  CAS  PubMed  Google Scholar 

  6. Fisher B, Costantino JP, Wickerham DL, Cecchini RS, Cronin WM, Robidoux A, et al. Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst 2005;97:1652–1662.

    Article  CAS  PubMed  Google Scholar 

  7. Gerber B, Krause A, Reimer T, Mylonas I, Makovitzky J, Kundt G, et al. Anastrozole versus tamoxifen treatment in postmenopausal women with endocrine-responsive breast cancer and tamoxifen-induced endometrial pathology. Clin Cancer Res 2006;12:1245–1250.

    Article  CAS  PubMed  Google Scholar 

  8. Gryspeerdt S, Van Hoe L, Bosmans H, Baert AL, Vergote I, Marchal G. T2-weighted MR imaging of the uterus: comparison of optimized fast spin-echo and HASTE sequences with conventional fast spin-echo sequences. AJR Am J Roentgenol 1998;171:211–215.

    CAS  PubMed  Google Scholar 

  9. Nalaboff KM, Pellerito JS, Ben-Levi E. Imaging the endometrium: disease and normal variants. Radiographics 2001;21:1409–1424.

    CAS  PubMed  Google Scholar 

  10. Kochar SPS, Arora P, Chattopadhyay AB. Tamoxifen therapy for breast cancer and endometrial pathology. MJAFI 2005;61:313–315.

    Google Scholar 

  11. Geisler J, King N, Dowsett M, Ottestad L, Lundgren S, Walton P, et al. Influence of anastrozole (Arimidex), a selective, non-steroidal aromatase inhibitor, on in vivo aromatisation and plasma oestrogen levels in postmenopausal women with breast cancer. Br J Cancer 1996;74:1286–1291.

    CAS  PubMed  Google Scholar 

  12. Duffy S, Jackson TL, Lansdown M, Philips K, Wells M. Pollard S, et al. The ATAC (“Arimidex”, Tamoxifen, Alone or in Combination) adjuvant breast cancer trial: first results of the endometrial sub-protocol following 2 years of treatment. Hum Reprod 2006;21:545–553.

    Article  CAS  PubMed  Google Scholar 

  13. Bertelli G, Venturini M, Del Mastro L, Garrone O, Cosso M, Gustavino C, et al. Tamoxifen and the endometrium: findings of pelvic ultrasound examination. Breast Cancer Res Treat 1998;47:41–46.

    Article  CAS  PubMed  Google Scholar 

  14. 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.

    Article  CAS  PubMed  Google Scholar 

  15. Nakamura Y, Furutani N, Tamura I, Sanui Y, Sayo M, Ueda K. The number of estrogen receptors on the uterus change with age. Sanfujinkanojissai 2006;55:2083–2086 (in Japanese).

    Google Scholar 

  16. Koshiyama M, Yoshida M, Takemura M, Yura Y, Matsushita K, Hayashi M, et al. Immunohistochemical analysis of distribution of estrogen receptors and progesterone receptors in the postmenopausal endometrium. Acta Obstet Gynecol Scand 1996;75:702–706.

    Article  CAS  PubMed  Google Scholar 

  17. Hachisuga T, Hideshima T, Kawarabayashi T, Eguchi F, Emoto M, Shirakusa T. Expression of steroid receptors, Ki-67, and epidermal growth factor receptor in tamoxifentreated endometrium. Int J Gynecol Pathol 1999;18:297–303.

    Article  CAS  PubMed  Google Scholar 

  18. Tregón ML, Blümel JE, Tarín JJ, Cano A. The early response of the postmenopausal endometrium to tamoxifen: expression of estrogen receptors, progesterone receptors, and Ki-67 antigen. Menopause 2003;10:154–159.

    Article  PubMed  Google Scholar 

  19. Mourits MJ, Ten Hoor KA, van der Zee AG, Willemse PH, de Vries EG, Hollema H. The effects of tamoxifen on proliferation and steroid receptor expression in postmenopausal endometrium. J Clin Pathol 2002;55:514–519.

    CAS  PubMed  Google Scholar 

  20. Klijn JG, Blamey RW, Boccardo F, Tominaga T, Duchateau L, Sylvester R. Combined tamoxifen and luteinizing hormonereleasing hormone (LHRH) agonist versus LHRH agonist alone in premenopausal advanced breast cancer: a meta-analysis of four randomized trials. J Clin Oncol 2001;19:343–353.

    CAS  PubMed  Google Scholar 

  21. Weaver J, McHugo JM, Clark TJ. Accuracy of transvaginal ultrasound in diagnosing endometrial pathology in women with post-menopausal bleeding on tamoxifen. Br J Radiol 2005;78:394–397.

    Article  CAS  PubMed  Google Scholar 

  22. Ascher SM, Imaoka I, Lage JM. Tamoxifen-induced uterine abnormalities: the role of imaging. Radiology 2000;214:29–38.

    CAS  PubMed  Google Scholar 

  23. Ascher SM, Johnson JC, Barnes WA, Bae CJ, Patt RH, Zeman RK. MR imaging appearance of the uterus in postmenopausal woman receiving tamoxifen therapy for breast cancer: histopathologic correlation. Radiology 1996;200:105–110.

    CAS  PubMed  Google Scholar 

  24. ACOG committee opinion. No. 336: tamoxifen and uterine cancer. Obstet Gynecol 2006;107:1475–1478.

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Authors and Affiliations

  1. Department of Radiology, Kobe City Medical Center General Hospital, 4-6 Minatojimanakamachi, Chuo-ku, Kobe, 650-0046, Japan

    Junko Ochi

  2. Department of Radiology, Kyoto City Hospital, Kyoto, Japan

    Junko Ochi & Katsumi Hayakawa

  3. Department of Surgery, Kyoto City Hospital, Kyoto, Japan

    Yoshio Moriguchi

  4. Department of Pathology, Kyoto City Hospital, Kyoto, Japan

    Yoji Urata

  5. Department of Radiology, Kyoto University Hospital, Kyoto, Japan

    Akira Yamamoto & Kanae Kawai

Authors
  1. Junko Ochi
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  2. Katsumi Hayakawa
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  3. Yoshio Moriguchi
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  4. Yoji Urata
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  5. Akira Yamamoto
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  6. Kanae Kawai
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Correspondence to Junko Ochi.

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Ochi, J., Hayakawa, K., Moriguchi, Y. et al. Uterine changes during tamoxifen, toremifene, and other therapy for breast cancer: evaluation with magnetic resonance imaging. Jpn J Radiol 28, 430–436 (2010). https://doi.org/10.1007/s11604-010-0446-9

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  • DOI: https://doi.org/10.1007/s11604-010-0446-9

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