ABSTRACT
Objective: To determine the role of transvaginal ultrasound, doppler velocimetry, saline infusion sonography and office hysteroscopy with endometrial biopsy and endocervical curettage in the detection of endometrial pathologies among breast cancer patients using Tamoxifen and subsequently recommend an acceptable cost effective protocol for the surveillance and follow up of these patients. Methodology: The study design is a descriptive type. Endometrial assessment was carried out using transvaginal ultrasound, doppler velocimetry, saline infusion sonography and office hysteroscopy with endometrial biopsy and endocervical curettage on initial consult. They were asked to follow up after 6 months during which time the same procedures will be repeated and performed. Results: Twenty one women were recruited to this study. The mean age of the subjects was 50.33 years. Of the 21 women in the study, 13 were postmenopausal and 8 were premenopausal. The mean age of menarche and menopause was 13.05 and 49.15 years, respectively. The body mass index was 23.92 (SD +/- 2.54). Other demographic characteristics were as follows; 19 percent had a history of oral contraceptive use, 35 percent were nulligravid, and 4.7 percent had a history of infertility x 9 years. The mean age when breast cancer was initially recognized was 47 years. Majority of patients (66.60 percent) had stage II disease. Seventy six percent was initially diagnosed by biopsy and the rest by fine needle aspiration cytology. All underwent modified radical mastectomy except for a 37 year old nulligravid who underwent quadrantectomy and axillary clearance. Eighteen (8-7.7 percent) of which showed ductal carcinoma on histopathologic examination. The mean duration of tamoxifen intake was 24 months. Women with breast cancer and taking Tamoxifen had a significant increase of vaginal bleeding on 6th month follow up. (P=0.00). On transvaginal ultrasound, a significant increase in the number of patients had thicker endometrium on 6th month follow up (P value 0.03). However, the role of Doppler and saline infusion sonography on the surveillance of the endometrium was not significant. Conclusion: A management scheme for the surveillance of the endometrium on breast cancer patients on Tamoxifen cannot be suggested at the moment and requires a long term follow up of these patients.