J Clin Oncol 2002; 20:2758.
All abnormal bleeding or spotting should be investigatedHysteroscopy is generally accepted as the gold standard for evaluating the endometrial cavity. Ultrasound measurement of endometrial thickness is a useful noninvasive technique for preliminary evaluation of such women. These results led the authors to conclude that the benefit of tamoxifen therapy for breast cancer outweighs the potential increase in endometrial cancer being reported.The etiology of tamoxifen-associated endometrial neoplasia has not been established. Postmenopausal estrogen replacement therapy generally induces increased cellular maturity and, consequently, increases the KPI. Consequently, a large number of women, including healthy young patients with no history of cancer, will be subjected to the long-term effects of tamoxifen. Two patients in the control group also had endometrial cancer. Fornander T, Cedermark B, Mattsson A, et al: Adjuvant tamoxifen in early breast cancer: Occurrence of new primary cancers. Some have proposed annual endometrial sampling, although this is not without its difficulties. Consequently, a large number of women will be subjected to both the benefits and potential risks of long-term tamoxifen therapy. This study failed to demonstrate any increase in precancerous or cancerous endometrial lesions associated with tamoxifen treatment.Gal et al [18] reported an 18% incidence of endometrial hyperplasia in random endometrial biopsies obtained from 38 breast cancer patients who had received tamoxifen at a dosage of 20 mg/day for at least 12 months.
This found that women were significantly more likely to have a documented endometrial thickness greater than 5 mm on at least one follow‐up ultrasound without an increased risk of endometrial hyperplasia or endometrial carcinoma.After the menopause, chronic endometritis can easily develop in low resistance atrophic endometrium and may be associated with necrotic polyps or carcinoma. All significant endometrial pathology was found in asymptomatic patients with an endometrial width greater than 5 mm on transvaginal sonography. Tuberculosis is a rare cause, although in some countries tuberculosis is not an uncommon aetiologic agent. The presence of a hydroxyl group in this compound destabilizes the ethylene bond, allowing isomerization of the compound to its E isomer, a potent estrogen agonist. Proc Am Soc Clin Oncol, 1994.20. While stimulating the growth of the endometrial tumor, tamoxifen had no effect on breast tumor growth and had an antagonistic action on the estradiol-stimulated growth of breast tumors.The estrogenic effect of tamoxifen on the female genital tract has also been demonstrated clinically. Gynecol Oncol 45:118-128, 1992.24.
Typically the endometrial glands are arranged with the long axis of the glands parallel to the surface epithelium.Although vaginal bleeding is common on presentation, endometrial polyps may be asymptomatic, and an incidental finding on imaging for other indications.Co‐existing cervical and endometrial polyps will be present in 24–27% of women at presentation.Most endometrial polyps are benign. Of the 43 patients in the tamoxifen-treated group who had an endometrial thickness of 5 mm or more, 17 (39.5%) had endometrial polyps; however, 22 (51.2%) had no abnormal pathologic findings. Radiotherapy or chemotherapy can also cause senile endometritis.Although the causative organisms of acute endometritis are numerous, the inflammatory reactions to them are generally the same.
This yielded an average annual hazard rate for endometrial cancer of 0.7/1,000. In addition, tamoxifen increased the levels of functional progesterone receptors, providing further evidence for the estrogenic potential of tamoxifen.Gottardis et al [15] demonstrated in athymic mice the contrasting actions of tamoxifen on the growth of ER-positive breast and endometrial cancer cell lines. Postmenopausal bleeding (PMB) is the most common reason for referral to gynaecological rapid access clinics.
Two patients in the tamoxifen group had endometrial hyperplasia, and one patient had endometrial cancer at the time of curettage.
Boccardo et al [16] investigated the estrogen-like effect of tamoxifen on the vaginal epithelium.
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