Effects of Adjuvant Tamoxifen on the Endometrium in Postmenopausal Women With Breast Cancer: A Prospective Long-Term Study Using Transvaginal Ultrasound

2000 ◽  
Vol 18 (20) ◽  
pp. 3464-3470 ◽  
Author(s):  
Bernd Gerber ◽  
Annette Krause ◽  
Heiner Müller ◽  
Toralf Reimer ◽  
Thomas Külz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
False Positive Rate ◽  
Postmenopausal Breast Cancer ◽  
Diagnostic Procedures ◽  
Breast Cancer Patients ◽  
Long Term Study ◽  
Asymptomatic Patients ◽  
Positive Rate

PURPOSE: To study the value of transvaginal ultrasound (TVS) in endometrial screening of postmenopausal breast cancer patients treated with tamoxifen. PATIENTS AND METHODS: In 247 tamoxifen-treated (20 to 30 mg/d for ≥ 2 years) women and 98 controls, the endometrium was prospectively followed-up by means of TVS every 6 months for up to 5 years. Patients with homogeneous endometrium of more than 10-mm thickness were then scanned repeatedly every 3 months. RESULTS: The mean endometrial thickness was 3.5 ± 1.1 mm before treatment and increased to a maximum of 9.2 ± 5.1 mm after 3 years of tamoxifen application (P < .0001), which was significantly (P < .0001) thicker compared with controls. Fifty-two asymptomatic patients with thickened or morphologically suspect endometrium underwent hysteroscopy and dilatation and curettage (D&C), resulting in four uterine perforations. Histopathologically, atrophy was found in 38 patients (73.1%), polyps in nine, hyperplasia in four, and endometrial cancer in one case. In 20 screened patients who reported vaginal bleeding, five atrophies (25%), five polyps, four hyperplasias, and two endometrial cancers were found. Before hysteroscopy and D&C were performed, 36 (69.2%) of 52 asymptomatic and four (20%) of 20 symptomatic patients were scanned by repeated TVS over 2 to 30 months. Invasive diagnostic procedures were significantly (P < .05) more frequent in younger and obese patients. In the controls, one asymptomatic polyp and one symptomatic hyperplasia were found. CONCLUSION: In tamoxifen-treated patients, TVS offered a high false-positive rate, even with a cutoff value of 10 mm for endometrial thickness and repeated TVS scans. Increased iatrogenic morbidity and only one asymptomatic endometrial carcinoma do not warrant endometrial screening by TVS in tamoxifen-treated patients.

Investigation of Endometrial Abnormalities in Asymptomatic Women Treated With Tamoxifen and an Evaluation of the Role of Endometrial Screening

1999 ◽  
Vol 17 (7) ◽  
pp. 2050-2050 ◽  
Author(s):  
C.D.B. Love ◽  
B. B. Muir ◽  
J. B. Scrimgeour ◽  
R. C.F. Leonard ◽  
P. Dillon ◽  
...  
Keyword(s):  
Breast Cancer ◽  
False Positive ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
False Positive Rate ◽  
Low Frequency ◽  
Endometrial Thickening ◽  
Increased Risk ◽  
Outpatient Hysteroscopy ◽  
Asymptomatic Women

PURPOSE: Tamoxifen is the most commonly prescribed adjuvant therapy for women with breast cancer. It has agonist activity on the endometrium and is associated with an increased risk of endometrial cancer. The aim of this study was to evaluate whether screening with transvaginal ultrasound (TV USS) with or without hysteroscopy is worthwhile. PATIENTS AND METHODS: A total of 487 women with breast cancer, 357 treated with tamoxifen and 130 controls, were screened with TV USS, and endometrial thickness was measured. Women with thickened endometrium underwent outpatient hysteroscopy. RESULTS: Length of time on tamoxifen ranged from 5 to 191 months (mean, 66 months), and endometrial thickness ranged from 1 to 38 mm (mean, 7.3 mm). Women treated with tamoxifen had significantly thicker endometrium than did controls (P < .0001). There was a statistically significant (P < .0001) positive correlation between length of time on tamoxifen and endometrial thickness. One hundred forty-five women had endometrium greater than 5 mm on USS, and 134 underwent successful outpatient hysteroscopy, 61 of whom had atrophic endometrium, resulting in a 46% false-positive scan rate. The remaining women all had benign features to explain the USS findings. CONCLUSION: TV USS detects a high incidence (41%) of apparent endometrial thickening in women treated with tamoxifen, although 46% had atrophic endometrium on further assessment, and none of the remaining asymptomatic women had significant lesions. Length of time on tamoxifen relates to endometrial thickening as measured by TV USS. TV USS is a poor screening tool because of the high false-positive rate. The low frequency of significant findings suggests that endometrial screening in asymptomatic women is not worthwhile.

Risk of Endometrial Cancer in Breast Cancer Patients under Long-Term Adjuvant Treatment with Tamoxifen

1998 ◽  
Vol 84 (1) ◽  
pp. 21-23 ◽  
Author(s):  
Silvia Cecchini ◽  
Stefano Ciatto ◽  
Rita Bonardi ◽  
Antonia Mazzotta ◽  
Paolo Pacini ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endometrial Cancer ◽  
Cancer Patients ◽  
Endometrial Thickness ◽  
Postmenopausal Breast Cancer ◽  
Cancer Surveillance ◽  
Tamoxifen Treatment ◽  
Adjuvant Tamoxifen ◽  
Breast Cancer Patients

Aims To evaluate the relative risk of endometrial cancer with respect to the expected underlying incidence in breast cancer patients undergoing long-term adjuvant tamoxifen therapy. Methods A total of 1010 postmenopausal breast cancer patients receiving adjuvant tamoxifen and with a first negative endometrial ultrasonography (cutoff for abnormal endometrial thickness >5 mm) were followed by annual transvaginal ultrasonography. Abnormal endometrial thickness prompted an outpatient endometrial biopsy or curettage under anesthesia in the case of cervical stenosis and increasing endometrial thickness. The standardized incidence ratio (SIR) with respect to underlying incidence was determined. Results A total of 1,010 eligible subjects who had been receiving tamoxifen for an average of 51 months were enrolled and followed for a total of 2,361 patient-years between January 1993 and December 1996. Five cases of endometrial cancer were observed in the study period: 1 was detected at screening, and 4 were diagnosed for vaginal bleeding in the interval between screening examinations. SIR was 4.0 (95% confidence interval, 1.39.4) and increased to 4.8 (CI, 1.6-10.5) when the single cancer detected at first screening was considered as incident. Conclusions This study adds evidence to the hypothesis that long-term tamoxifen treatment may be responsible for a relevant increase in the risk of developing endometrial cancer. Surveillance based on endometrial ultrasonography was poorly sensitive, but the favorable stage at diagnosis of screen-detected or interval endometrial cancers does not support a more aggressive screening approach.

False Positive Tumor Markers: Elevation in Patients with Breast Cancer on FAC-type Chemotherapy and Correlation with the Development of Hand-foot Syndrome

1996 ◽  
Vol 11 (4) ◽  
pp. 203-206 ◽  
Author(s):  
L.B. Tyshler ◽  
G.M. Longton ◽  
G.K. Ellis ◽  
R.B. Livingston
Keyword(s):  
Breast Cancer ◽  
Tumor Marker ◽  
Cancer Patients ◽  
Tumor Markers ◽  
False Positive ◽  
False Positive Rate ◽  
Breast Cancer Patients ◽  
Hand Foot Syndrome ◽  
Positive Rate ◽  
Fac Chemotherapy

Breast cancer patients on dose-intensive chemotherapy often have elevated tumor markers during the course of treatment. Our objective was to estimate the incidence of a “false positive” tumor marker screen and to determine whether hand-foot epithelial damage was correlated. Data from 53 patients with high risk primary breast cancer who had undergone adjuvant or neoadjuvant 5FU-containing chemotherapy (FAC or FAC plus G-CSF) for 3 to 12 months were reviewed. The relationship between tumor marker elevation and disease recur- rence, regimen intensity, and the occurrence of hand-foot syndrome was examined. Thirty-three of the 53 patients had elevated tumor markers in the absence of recurrent disease. The false positive rate was higher in patients who underwent FAC plus G-CSF chemotherapy than in patients who underwent FAC chemotherapy (92% vs 55%, p = .01). A false positive marker screen was associated with the occurrence of hand-foot syndrome even when the effect of regimen was accounted for by stratification (p=.01). Tumor marker screening of breast cancer patients on this type of adjuvant chemotherapy has poor specificity for recurrent malignancy. These data suggest tumor marker elevation may be an indicator of epithelial toxicity during chemotherapy, manifested clinically as hand-foot syndrome.

Endometrial effects of exemestane compared to tamoxifen within the TEAM trial: Results of a prospective randomized study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 572-572 ◽  
Author(s):  
D. G. Kieback ◽  
N. Harbeck ◽  
W. Bauer ◽  
P. Hadji ◽  
G. Weyer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endometrial Hyperplasia ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Randomized Study ◽  
Postmenopausal Breast Cancer ◽  
Cox Proportional Hazards ◽  
Time Interval ◽  
Open Label ◽  
Logrank Test

572 Background: A prospective open label randomized multicenter substudy was performed in the German TEAM Trial Group to compare the effects of the irreversible aromatase antagonist Exemestane (EXE) and the ER agonist/antagonist Tamoxifen (TAM) on the endometrium during adjuvant treatment for postmenopausal estrogen receptor positive breast cancer. Methods: Transvaginal Ultrasound Scans (TVS) were performed at baseline, 6 and 12 months of treatment if no proliferation >5mm was present, and in 3 months intervals if endometrial thickness exceeded 5mm. Intent-to-treat analysis was performed based on 158 patients. Primary endpoint was the time interval from randomization to the earliest occurrence of endometrial hyperplasia > 10mm. Secondary endpoints were the time from randomization to endometrial hyperplasia > 5mm and the time interval from randomization to vaginal bleeding. Analysis of Time to Event Curves was performed by Kaplan-Meier method, analysis of differences between treatments by two-sided Logrank test and Cox Proportional Hazards. Differences in frequency were compared by Fisher‘s Exact Test. Results: 65 patients were available for analysis in the TAM arm, 78 in the EXE arm. Both groups were comparable regarding age, height, tumor grade,and stage. Median follow-up was 727 (EXE) and 526 days (TAM). In this time period, there were no (EXE) vs. 11 (TAM) cases of endometrial hyperplasia >10mm (p<0.0001), 11 (EXE) vs. 34 (TAM) patients with hyperplasia >5mm (p< 0.006). In total, endometrial hyperplasia was observed 11 times in the EXE arm vs. 45 times in the TAM arm (p<0.0001). Time to endometrial hyperplasia was significantly longer in the EXE group (p<0.0001); HR was 0.160 indicating an 84% risk reduction of hyperplasia in the EXE group. Increase in endometrial thickness from baseline to 6mo. was 2.94mm (EXE) vs. 5.41mm(TAM), from baseline to 12 mo 2.64mm vs. 6.0 mm respectively (p<0.0006). Only 1 patient underwent histological sampling in the EXE group (no hyperplasia) vs. 18 in the TAM subset. Conclusions: In a TEAM subprotocol, irreversible inactivation of aromatase by EXE resulted in significantly less endometrial proliferation than TAM during adjuvant therapy of receptor positive postmenopausal breast cancer. No significant financial relationships to disclose.

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