Endometrial abnormalities in postmenopausal breast cancer patients.

OBJECTIVE: To determine the prevalence of endometrial thickening and pelvic pathologies in postmenopausal breast cancer patients. MATERIAL AND METHOD: A total of 66 postmenopausal breast cancer patients receiving treatment at Srinagarind Hospital from 1 July 1999 to 31 August 2000 were included in the study. Patients who had been treated with hormones such as tamoxifen or progestins were not eligible for this study. Thorough history taking and physical examination as well as transvaginal ultrasonography were conducted in all study patients. Fractional curettage was carried out and the specimens obtained were sent for pathological examination in all patients whose endometrial thickness was found to be greater than 5 mm on the ultrasound scan. RESULTS: Among the 66 patients included in this study, the mean age was 54.97 years. The majority of patients (75.76%) had stage II disease. The mean +/- SD of endometrial thickness found in this study was 3.55 +/- 1.72 mm. The prevalence of thickened endometrium (defined as ET > 5 mm from TVS) was 10.60% (7 from 66 cases). Other pelvic pathologies detected by ultrasonography were myoma uteri (4.55%) and ovarian mass (1.52%). Among the seven patients whose endometrial thickness was found to be greater than 5 mm, results of curettage specimens revealed inadequate tissue obtained (42.85%), atrophic endometrium (28.57%), active endometrial gland (14.29%), and scanty stromal cell (14.29%). CONCLUSION: The prevalence of thickened endometrium in postmenopausal breast cancer patients found in this study was interestingly high. The pathological results of such cases, however, turned out to be negative for neoplastic changes in all cases. Further study, thus, is needed before precise recommendation could be made regarding the value of TVS screening in breast cancer patients not taking tamoxifen.

Increased risk of endometrial abnormalities in breast cancer patients taking tamoxifen: the need for gynaecologic surveillance.

OBJECTIVE: To evaluate the risk of abnormally thickened endometrium associated with tamoxifen treatment in postmenopausal breast cancer patients. METHODS: Two groups of asymptomatic postmenopausal breast cancer patients were recruited in the study. The first consisted of 70 patients taking 20mg/day of tamoxifen for at least 6 months. The second group included 140 patients without tamoxifen treatment. Endometrial evaluation using transvaginal ultrasonography (TVS) was conducted for all patients. Fractional curettage was carried out for patients whose endometrial thickness was greater than 5 mm on TVS. RESULTS: The prevalence of abnormally thickened endometrium (greater than 5 mm on TVS) was significantly higher in patients receiving tamoxifen (58.57% VS 10.71 %, P = 0.0001). Patients undergoing tamoxifen treatment had a 5.61 relative risk of developing abnormally thickened endometrium (95% CI= 2.65 -11.86). CONCLUSION: Tamoxifen significantly increases the risk of developing abnormally thickened endometrium in postmenopausal breast cancer patients. There is, thus, a true need for gynaecologic surveillance in such patients to early detect neoplastic change of endometrium that may arise as a result of tamoxifen use.

Surveillance for endometrial cancer in postmenopausal breast cancer patients taking tamoxifen.

OBJECTIVES: To determine the prevalence of endometrial thickening and endometrial pathologies in postmenopausal breast cancer patients taking tamoxifen. MATERIALS AND METHODS: A total of 37 postmenopausal breast cancer patients receiving 20 microg/day of tamoxifen treatment for at least 6 months at Srinagarind hospital were included in the study. Thorough history taking and physical examination as well as transvaginal ultrasonography were conducted for all patients. Fractional curettage was carried out in those whose endometrial thickness was found to be greater than 5 mm. RESULTS: Among 37 patients included in this study, the mean age was 56.35 years. The mean body weight and mean body mass index was 60.88 kg and 26.03 kg/m(2), respectively. The majority of patients (75.68%) had stage II disease. The mean + SD of endometrial thickness found in this study was 7.53 + 5.16 mm. The prevalence of thickened endometrium (defined as ET > 5mm from TVS) was 59.46%. Among the 19 patients for whom fractional curettage was conducted, the majority (73.69%) exhibited inadequate endometrium for evaluation. Atrophic endometrium and other unremarkable changes were found in 21.05% of patients and it is important to note that endometrial adenocarcinoma was detected in 1 case (5.26%). CONCLUSIONS: The prevalence of thickened endometrium in postmenopausal breast cancer patients taking tamoxifen found in this study was extraordinarily high. These is, however, a discrepancy between the value and that for endometrial abnormalities detected histologically.