Clinical Research
BibTex RIS Cite

Endometrial Pathologies in Women Using Tamoxifen Due to Breast Cancer

Year 2008, Volume: 2 Issue: 3, 363 - 371, 20.11.2008

Işık Üstüner

Abstract

Tamoxifen is a selective estrogen receptor modulator drug used in early and metastatic breast cancer patients. The aim of this study is to examine endometrial pathologies in those who use tamoxifen because of the breast cancer. Seventyone cases on tamoxifen who was followed-up due to breast cancer were assessed retrospectively. In accordance with the follow-up protocol, endometrial biopsy and histopathological examinations were performed. The mean age of the cases was 51.0 ± 12.7 years. The mean time duration after the diagnosis of breast cancer was 2.3 ±1.5 years; tamoxifen usage time was 1.5 ±1.1 years in average. Endometrial biopsy was performed in 27 of the 71 (38.0%) cases. 12 of those cases were premenopausal and the remaining 15 were postmenopausal. Insufficient sampling was reported in 19 of the 27 (70.4%) cases. Hysteroscopic biopsy or hysterectomy was made in 7 of the 19 undiagnosed cases due to the insufficient sampling. The results of the 7 cases were: 5 endometrial polyps and/or simple endometrial hyperplasia, 1 endometrial proliferation, and 1 case without any endometrial pathology. When obtaining endometrial biopsies in patients who use Tamoxifen, curettage procedure should be done more aggressively or further examinations and assessments should be instituted to make a definitive pathologic diagnosis and avoid not being able to diagnose histopathologically.

Keywords

Tamoxifen endometrial pathology breast cancer

References

  • 1. ACOG Committee Opinion 336. Tamoxifen and uterine cancer. Obstet Gynecol 2006; 107: 1475-8.
  • 2. Early Breast Cancer Trialists’ Collaborative Group. Systematic treatment of early breast cancer by hormonal, cytotoxic or immune therapy. Lancet 1992;339:1-15.
  • 3. Barakat RR. Tamoxifen and endometrial neoplasia. Clin Obstet Gynaecol 1996;39:629-40.
  • 4. Keskin N, Salihoğlu Y, Topuz S. Tamoksife-nin endometrium kanseri ile ilşkisi Endokrinolojide Diyalog 2007;1:22-5.
  • 5. Early Breast Cancer Trialists’ Collaborative Group. Tamoxifen for early breast cancer: an overview of the randomized trials. Lancet 1998;351:1415-67.
  • 6. Deligdisch L, Kalir T, Cohen CJ, de Latour M, Le Bouedec G, Panault-Llorca F. Endometrial histopathology in 700 patients treated with tamoxifen for breast cancer Gynecol Oncol 2000;78:181-6.
  • 7. Cheng W, Lin H, Torng P, Huang S. Comparison of endometrial changes among symptomatic tamoxifen-treated and nontreated premenopausal and postmenopausal breast cancer patients Gynecologic Oncology 1997;66:233-7. I KAYNAKLAR
  • 8. Franchi M, Ghezzi F, Donadello N, Zanaboni F. Beretta P, Bolis P. Endometrial thickness in tamoxifen-treated patients: an independent predictor of endometrial disease Obstet Gynecol 1999;93.1004-8.
  • 9. Akhan SE, lyibozkurt AC, Öztekin M, Delier H, Topuz S, Turfanda A. Tamoksifen kullanan asemptomatik postmenopozal meme kanserli hastalarda transvajinal ultrason ve histeroskopi bulgularının endometriyal histoloji ile karşılaştırılması. Türkiye Klinikleri J Gynecol Obst 2007;17:342-9.
  • 10. Cohen I. Endometrial pathologies associated with postmenopausal tamoxifen treatment. Gynecol oncol 2004;94:256-66.
  • 11. Perez EA. Safety profiles of tamoxifen and the aromatase inhibitors in adjuvant therapy of hormone-responsive early breast cancer. Ann Oncol 2007; 18 (Suppl 8):26-35.
  • 12. Akhan SE, Büyükören A, Turfanda A, Bilgin M, lyibozkurt C. Comparison of the results of transvajinal ultrasonography and endometrial sampling in 21 postmenopausal symptomatic breast cancer patienats who have used Tamoxifen. T Klin Jinekol Obst 2000;10:40-4.
  • 13. Akercan F, Çırpan T, İtil İM, Yıldız S. Tamoksifen kullanan ve Transvajinal Ultrasonografi ile endometrial kalınlaşma saptanan kadınlarda endometrial hiperplazi görülme oranları. Uzmanlık Sonrası Eğitim ve Güncel Gelişmeler Dergisi 2005;2:210-3.
  • 14. Haberal A, Erten A, Yencilek R, Çalışkan E, Narin MA Tamoksifen kullanan meme kanserli postmenopozal olgularda, kemik mineral ve endometrium kalınlığının değerlendirilmesi. Türk Fertilite Dergisi 2002;10:240-5.
  • 15. Exacoustos C, Zupi E, Cangi B, Chiaretti M, Arduini D, Romanini C. Endometrial evaluation in postmenopausal breast cancer patients receiving tamoxifen: an ultrasound, color flow Doppler, hysteroscopic and histological study. Ultrasound Obstet Gynecol. 1995;6: 435-42.
  • 16. Hann LE, Giess CS, Bach AM, Tao Y, Baum HJ, Barakat RR. Endometrial thickness in tamoxifen-treated patients: correlation with clinical and pathologic findings. AJR Am J Roentgenol 1997;68:657-61.
  • 17. Neven P, Vernaeve H. Guidelines for monitoring patients taking tamoxifen treatment Drug Saf 2000;22:1-11.
  • 18. Timmerman D, Deprest J, Vergote I. Tamoxifen induced endometrial polyp N Engl J Med 1997;336:1389-90.
  • 19. Konefka ES, Konefka T, Jassem J. The effects on tamoxifen on the female genital tract. Cancer Treat rev 2004;30:291-301.
  • 20. Daniel Y, Inbar M, Bar-Am A, Peyser MR, Lessing JB.The effects of tamoxifen treatment on the endometrium. Fertil Steril 1996;65:1083-9.
  • 21. Garuti G, Grossi F, Centinaio G, Sita G, Naili G, Luerti M. Pretreatment and prospective assessment of endometrium in menopausal women taking tamoxifen for breast cancer. Eur J Obstet Gynecol Reprod Biol. 2007;132:101-6.
  • 22. Çitil İ, İyibozkurt AC, Saygılı H Tamoksifen ve endometriyum üzerine etkisi Türkiye Klinikleri J Gynecol Obst 2006;16:53-7.
  • 23. d’Arailh AS, Michy T. Pioud R, Dravet F, Clas-se JM. Uterine abnormalities in non menopausal women who received tamoxifen for breast cancer adjuvant therapy Gynecol Obstet Fertil 2007;35:1215-9.
  • 24. Güdücü N, Turan C, Salepçi T. Tamoksifen kullanan asemptomatik postmenopozal hastalarda endometriumun transvajinal ultraso-nografi, şalin infüzyon sonografi, histeroskopi ve endometrial küretaj ile değerlendirilmesi. T Klin Jinekol Obstet 2001 ;11:378-81.
  • 25. Mounts MJ, De Vries EG, Willemse PH, Ten Hoor KA, Hollema H, Van der Zee AG. Tamoxifen treatment and gynecologic side effects: a review. Obstet Gynecolo 2001 ;97:855-66.
  • 26. Chen P, Yang CC, Chen YJ, Wang PH Tamoxifen-induced endometrial cancer Eur J Gynaecol Oncol 2003;24:135-7.
  • 27. Berliere M, Charlese A, Galant C, Donnez J. Uterine side effects of tamoxifen: a need for systematic pretreatment screening. Obstet Gynecol 1998;91:40-4.
  • 28. Mounts MU, Van der Zee AG, Willemse PH, Ten Hoor KA, Hollema H, De Vries EG. Discrepancy between ultrasonography and hys-tersocopy in postmenopausal breast cancer patients using tamoxifen. Gynecol Oncol 1999;73:21-6.
  • 29. Cohen I, Altaras MM, Shapira J, Tepper R, Cordoba M, Figer A, Zalel Y, Dror Y, Beyth Y. Different coexisting endometrial histological features in asymptomatic postmenopausal breast cancer patients treated with tamoxifen. Gynecol Obstet Invest 1997;43: 60-3.
  • 30. 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;78:394-7.
  • 31. Kedar RP, Bourne TH, Powles TJ, Collins WP, Ashley SE, Cosqrove DO, Campbell S. Effects of tamoxifen on uterus and ovaries of postmenopausal women in a randomised breast cancer prevention trial. Lancet 1994;343: 1318-21.
  • 32. Özşener S, Özoran A, İtil İ, Dikmen Y. Endo-metrail pathology of 104 postmenopausal breast cancer patients treated with tamoxifen Eur J Gynecol Oncol 1998;19:580-3.
  • 33. Markovitch O, Tepper R, Aviram R, Fishman A, Shapira J, Cohen I. The value of sonohy-sterography in the prediction of endometrial pathologies in asymptomatic postmenopausal breast cancer tamoxifen-treated patients. Gynecol Oncol 2004;94:754-9.
  • 34. Cohen I, Azaria R, Bernheim J, Tepper R, Sharony R, Beyth Y. Comparison of endometrial pathologies collected by hysteroscopy and hysterectomy in postmenopausal breast cancer patients. Eur J Gynecol Oncol 2000;21:418-22.
  • 35. Cecchini S, Ciatto S, Bonardi Mazotat A, Grazzini G, Pacini P, Muraca MG. Screening by ultrasonography for endometrial carcinoma in postmenopausal breast cancer patients under adjuvant tamoxifen. Gynecol Oncol 1996;60:409-11.
  • 36. Taponeco F, Curcio C, Fasciani A, Giuntini A, Artini PG, Fornaciari G, Petraglia F, Genaz-zani AR. Indication of hysteroscopy in tamoxifen treated breast cancer patients. J Exp Clin Cancer Res 2002;21:37-43.
  • 37. Neven P, Vergote I. Controversies regarding tamoxifen and uterine carcinoma. Curr Opin Obstet Gynecol 1998;10:9-14.
  • 38. Timmerman D, Deprest J, Bourne T, Van den Berghe I Collins WP, Vergote I. A randomized trial on the use of ultrasonography or office hysteroscopy for endometrial assessment in postmenopausal patients with breast cancer who were treated with tamoxifen. Am J Obstet Gynecol 1998;179:62-70.
  • 39. Machado F, Rodriguez JR, Leon JP, Rodriguez JR, Parrilla JJ, bad L. Tamoxifen and endometrial cancer. Is screening necessary? A review of the literature. Eur J Gynecol Oncol 2005;26:257-65.
  • 40. Erhan Y, Zekioğlu O, Terek MC, Akman L, Öz-saran A, Dikmen Y, Şendağ F. Adjuvan tamoksifen tedavisi alan meme kanserli hastalarda endometrial neoplazi: non-endo-metrioid alt gruplarının sunumu. Ege Tıp Dergisi 2005;44:101-5.

Meme Kanseri Nedeniyle Tamoksifen Kullanan Kadınlarda Endometrial Patolojiler

Year 2008, Volume: 2 Issue: 3, 363 - 371, 20.11.2008

Işık Üstüner

Abstract

Tamoksifen, erken ve metastatik meme kanseri hastalarında yaygın olarak kullanılan selektif östrojen reseptör modülatörü bir ilaçtır. Bu çalışmanın amacı meme kanseri nedeniyle tamoksifen kullananlarda endometrial patolojileri incelemektir. Meme kanseri nedeniyle takip edilen ve tamoksifen kullanan 71 olgu retrospektif olarak değerlendirildi. Olgularda; takip protokolüne göre endometrial biyopsi ve histopatolojik inceleme yapıldı. Olguların yaşları ortalama 51.0 ± 12.7 yıldı. Meme kanseri tanısı aldıktan sonra geçen süre ortalama 2.3 ±1.5 yıl, Tmx kullanım süresi ortalama 1.5 ± 1.1 yıl idi. 71 olgunun 27’sine (%38.0) endometrial biyopsi uygulandı. Bu olguların 12’si premenopozal, 15’i postmenopozal idi. 27 olgunun 19’unda (%70.4) yetersiz materyal rapor edildi. Negatif endometrial küretaj nedeniyle tanı koydurucu sonuç elde edilemeyen 19 olgudan 7 olguya histeroskopi eşliğinde biyopsi veya histerektomi uygulandı. 7 olgunun patoloji sonuçlarında, 5’in-de endometrial polip ve/veya basit atipisiz endometrial hiperplazi, 1 olguda proliferatif endometrium saptanırken 1 olguda endometrial patoloji saptanmadı. Tamoksifen kullanan olgularda probe küretaj ile alınan endometrial biyopsilerde histopatolojik tanı konamaması karşısında patolojiden emin olunabilmesi amacıyla küretaj işlemi daha agresif yapılmalı veya daha ileri tetkik ve değerlendirme yapılmalıdır.

Dr. H. Levent KESKİN, Dr. Nilüfer AKGÜN Dr. Tuba SEMERCİ, Dr. Işık ÜSTÜNER, Dr. Emine ÇELEN, Dr. Serpil AYDOĞMUŞ, Dr. Ayşegül ÇİNKAYA, Dr. Mustafa UZUN, Dr. Mehmet GÜMÜŞ, Dr. A. Filiz AVŞAR

Keywords

Tamoksifen endometrial patoloji meme kanseri

References

  • 1. ACOG Committee Opinion 336. Tamoxifen and uterine cancer. Obstet Gynecol 2006; 107: 1475-8.
  • 2. Early Breast Cancer Trialists’ Collaborative Group. Systematic treatment of early breast cancer by hormonal, cytotoxic or immune therapy. Lancet 1992;339:1-15.
  • 3. Barakat RR. Tamoxifen and endometrial neoplasia. Clin Obstet Gynaecol 1996;39:629-40.
  • 4. Keskin N, Salihoğlu Y, Topuz S. Tamoksife-nin endometrium kanseri ile ilşkisi Endokrinolojide Diyalog 2007;1:22-5.
  • 5. Early Breast Cancer Trialists’ Collaborative Group. Tamoxifen for early breast cancer: an overview of the randomized trials. Lancet 1998;351:1415-67.
  • 6. Deligdisch L, Kalir T, Cohen CJ, de Latour M, Le Bouedec G, Panault-Llorca F. Endometrial histopathology in 700 patients treated with tamoxifen for breast cancer Gynecol Oncol 2000;78:181-6.
  • 7. Cheng W, Lin H, Torng P, Huang S. Comparison of endometrial changes among symptomatic tamoxifen-treated and nontreated premenopausal and postmenopausal breast cancer patients Gynecologic Oncology 1997;66:233-7. I KAYNAKLAR
  • 8. Franchi M, Ghezzi F, Donadello N, Zanaboni F. Beretta P, Bolis P. Endometrial thickness in tamoxifen-treated patients: an independent predictor of endometrial disease Obstet Gynecol 1999;93.1004-8.
  • 9. Akhan SE, lyibozkurt AC, Öztekin M, Delier H, Topuz S, Turfanda A. Tamoksifen kullanan asemptomatik postmenopozal meme kanserli hastalarda transvajinal ultrason ve histeroskopi bulgularının endometriyal histoloji ile karşılaştırılması. Türkiye Klinikleri J Gynecol Obst 2007;17:342-9.
  • 10. Cohen I. Endometrial pathologies associated with postmenopausal tamoxifen treatment. Gynecol oncol 2004;94:256-66.
  • 11. Perez EA. Safety profiles of tamoxifen and the aromatase inhibitors in adjuvant therapy of hormone-responsive early breast cancer. Ann Oncol 2007; 18 (Suppl 8):26-35.
  • 12. Akhan SE, Büyükören A, Turfanda A, Bilgin M, lyibozkurt C. Comparison of the results of transvajinal ultrasonography and endometrial sampling in 21 postmenopausal symptomatic breast cancer patienats who have used Tamoxifen. T Klin Jinekol Obst 2000;10:40-4.
  • 13. Akercan F, Çırpan T, İtil İM, Yıldız S. Tamoksifen kullanan ve Transvajinal Ultrasonografi ile endometrial kalınlaşma saptanan kadınlarda endometrial hiperplazi görülme oranları. Uzmanlık Sonrası Eğitim ve Güncel Gelişmeler Dergisi 2005;2:210-3.
  • 14. Haberal A, Erten A, Yencilek R, Çalışkan E, Narin MA Tamoksifen kullanan meme kanserli postmenopozal olgularda, kemik mineral ve endometrium kalınlığının değerlendirilmesi. Türk Fertilite Dergisi 2002;10:240-5.
  • 15. Exacoustos C, Zupi E, Cangi B, Chiaretti M, Arduini D, Romanini C. Endometrial evaluation in postmenopausal breast cancer patients receiving tamoxifen: an ultrasound, color flow Doppler, hysteroscopic and histological study. Ultrasound Obstet Gynecol. 1995;6: 435-42.
  • 16. Hann LE, Giess CS, Bach AM, Tao Y, Baum HJ, Barakat RR. Endometrial thickness in tamoxifen-treated patients: correlation with clinical and pathologic findings. AJR Am J Roentgenol 1997;68:657-61.
  • 17. Neven P, Vernaeve H. Guidelines for monitoring patients taking tamoxifen treatment Drug Saf 2000;22:1-11.
  • 18. Timmerman D, Deprest J, Vergote I. Tamoxifen induced endometrial polyp N Engl J Med 1997;336:1389-90.
  • 19. Konefka ES, Konefka T, Jassem J. The effects on tamoxifen on the female genital tract. Cancer Treat rev 2004;30:291-301.
  • 20. Daniel Y, Inbar M, Bar-Am A, Peyser MR, Lessing JB.The effects of tamoxifen treatment on the endometrium. Fertil Steril 1996;65:1083-9.
  • 21. Garuti G, Grossi F, Centinaio G, Sita G, Naili G, Luerti M. Pretreatment and prospective assessment of endometrium in menopausal women taking tamoxifen for breast cancer. Eur J Obstet Gynecol Reprod Biol. 2007;132:101-6.
  • 22. Çitil İ, İyibozkurt AC, Saygılı H Tamoksifen ve endometriyum üzerine etkisi Türkiye Klinikleri J Gynecol Obst 2006;16:53-7.
  • 23. d’Arailh AS, Michy T. Pioud R, Dravet F, Clas-se JM. Uterine abnormalities in non menopausal women who received tamoxifen for breast cancer adjuvant therapy Gynecol Obstet Fertil 2007;35:1215-9.
  • 24. Güdücü N, Turan C, Salepçi T. Tamoksifen kullanan asemptomatik postmenopozal hastalarda endometriumun transvajinal ultraso-nografi, şalin infüzyon sonografi, histeroskopi ve endometrial küretaj ile değerlendirilmesi. T Klin Jinekol Obstet 2001 ;11:378-81.
  • 25. Mounts MJ, De Vries EG, Willemse PH, Ten Hoor KA, Hollema H, Van der Zee AG. Tamoxifen treatment and gynecologic side effects: a review. Obstet Gynecolo 2001 ;97:855-66.
  • 26. Chen P, Yang CC, Chen YJ, Wang PH Tamoxifen-induced endometrial cancer Eur J Gynaecol Oncol 2003;24:135-7.
  • 27. Berliere M, Charlese A, Galant C, Donnez J. Uterine side effects of tamoxifen: a need for systematic pretreatment screening. Obstet Gynecol 1998;91:40-4.
  • 28. Mounts MU, Van der Zee AG, Willemse PH, Ten Hoor KA, Hollema H, De Vries EG. Discrepancy between ultrasonography and hys-tersocopy in postmenopausal breast cancer patients using tamoxifen. Gynecol Oncol 1999;73:21-6.
  • 29. Cohen I, Altaras MM, Shapira J, Tepper R, Cordoba M, Figer A, Zalel Y, Dror Y, Beyth Y. Different coexisting endometrial histological features in asymptomatic postmenopausal breast cancer patients treated with tamoxifen. Gynecol Obstet Invest 1997;43: 60-3.
  • 30. 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;78:394-7.
  • 31. Kedar RP, Bourne TH, Powles TJ, Collins WP, Ashley SE, Cosqrove DO, Campbell S. Effects of tamoxifen on uterus and ovaries of postmenopausal women in a randomised breast cancer prevention trial. Lancet 1994;343: 1318-21.
  • 32. Özşener S, Özoran A, İtil İ, Dikmen Y. Endo-metrail pathology of 104 postmenopausal breast cancer patients treated with tamoxifen Eur J Gynecol Oncol 1998;19:580-3.
  • 33. Markovitch O, Tepper R, Aviram R, Fishman A, Shapira J, Cohen I. The value of sonohy-sterography in the prediction of endometrial pathologies in asymptomatic postmenopausal breast cancer tamoxifen-treated patients. Gynecol Oncol 2004;94:754-9.
  • 34. Cohen I, Azaria R, Bernheim J, Tepper R, Sharony R, Beyth Y. Comparison of endometrial pathologies collected by hysteroscopy and hysterectomy in postmenopausal breast cancer patients. Eur J Gynecol Oncol 2000;21:418-22.
  • 35. Cecchini S, Ciatto S, Bonardi Mazotat A, Grazzini G, Pacini P, Muraca MG. Screening by ultrasonography for endometrial carcinoma in postmenopausal breast cancer patients under adjuvant tamoxifen. Gynecol Oncol 1996;60:409-11.
  • 36. Taponeco F, Curcio C, Fasciani A, Giuntini A, Artini PG, Fornaciari G, Petraglia F, Genaz-zani AR. Indication of hysteroscopy in tamoxifen treated breast cancer patients. J Exp Clin Cancer Res 2002;21:37-43.
  • 37. Neven P, Vergote I. Controversies regarding tamoxifen and uterine carcinoma. Curr Opin Obstet Gynecol 1998;10:9-14.
  • 38. Timmerman D, Deprest J, Bourne T, Van den Berghe I Collins WP, Vergote I. A randomized trial on the use of ultrasonography or office hysteroscopy for endometrial assessment in postmenopausal patients with breast cancer who were treated with tamoxifen. Am J Obstet Gynecol 1998;179:62-70.
  • 39. Machado F, Rodriguez JR, Leon JP, Rodriguez JR, Parrilla JJ, bad L. Tamoxifen and endometrial cancer. Is screening necessary? A review of the literature. Eur J Gynecol Oncol 2005;26:257-65.
  • 40. Erhan Y, Zekioğlu O, Terek MC, Akman L, Öz-saran A, Dikmen Y, Şendağ F. Adjuvan tamoksifen tedavisi alan meme kanserli hastalarda endometrial neoplazi: non-endo-metrioid alt gruplarının sunumu. Ege Tıp Dergisi 2005;44:101-5.
There are 40 citations in total.

Details

Primary Language Turkish
Subjects Radiology and Organ Imaging, Clinical Sciences (Other)
Journal Section Research Article
Authors

Işık Üstüner

Publication Date November 20, 2008
Published in Issue Year 2008 Volume: 2 Issue: 3

Cite

APA Üstüner, I. (2008). Meme Kanseri Nedeniyle Tamoksifen Kullanan Kadınlarda Endometrial Patolojiler. Türk Tıp Dergisi, 2(3), 363-371.
 Download Cover Image

bf8427c2c5be3a8e93ed095426efd16e.png
Bu eser Creative Commons Atıf-GayriTicari (CC-BY-NC 4.0) Uluslararası Lisansı ile lisanslanmıştır.

All site content, except where otherwise noted, is licensed under a Creative Common Attribution Licence. (CC-BY-NC 4.0)