Endometrial Surveillance in Tamoxifen and Letrozole Treated Breast Cancer Patients

Abstract

Background: Our study aimed to assess the risk of endometrial pathologies after tamoxifen and aromatase inhibitors (AIs) adjuvant treatment for female breast cancer patients treated at Sultan Qaboos University Hospital in Oman.Materials and Methods: A total of 457 patients diagnosed with estrogen positive breast cancer between January 2011 and December 2018 were screened. Two hundred and four patients met the inclusion criteria, and their detailed clinicopathological and endometrial surveillance data were collected from their electronic health records.Results: All patients underwent endometrial assessment during tamoxifen or letrozole therapy. The mean diagnostic age of breast cancer patients is 43.6 years, ranging from 27-84 years. Eighty-three percent of those patients are premenopausal, and 17% are postmenopausal. The mean tamoxifen use duration was 33 months. The majority of patients, 123 (60.3%), have had tamoxifen for three years or less, 47 (23.1%) for 3-5 years, and only 22 (10.8%) were on tamoxifen for more than five years. Increased endometrial thickness was reported in 8% of the premenopausal and 14% of the postmenopausal group. Other endometrial pathologies that were detected are inactive endometrium three (1.47%), atrophic endometrium three (1.47%), serous carcinoma one (0.50%), endometrial cancer two (0.98%), and chronic endometritis one (0.50%), which were not significantly associated with tamoxifen or letrozole therapy duration. Two patients have developed endometrial cancer, and both are postmenopausal and > 60 years old.Conclusions: Tamoxifen and letrozole did not increase the risk of endometrial cancer in premenopausal patients. Breast Cancer (BC) patients on tamoxifen or letrozole might need a pre-treatment endometrial evaluation and explanation of alarming symptoms to guide further endometrial surveillance.

An Update on Tamoxifen and the Chemo-Preventive Potential of Vitamin E in Breast Cancer Management

“…In another random-effect meta-analysis report involving 53,000 women, the risk of endometrial cancer and of vascular and thrombotic events appeared to be less in premenopausal women [ 116 ]. Consequently, TAM did not increase the risk of endometrial cancer in premenopausal patients [ 117 ].…”

Современный Взгляд На Изучение Факторов Риска, Приводящих К Малигнизации Гиперпластических Процессов Эндометрия: Обзор Литературы

“…Но несмотря на это, он имеет достаточно серьезные побочные эффекты, о которых нельзя забывать акушер-гинекологам и онкологам. Эти побочные эффекты связаны со способностью тамоксифена оказывать частичное антагонистическое действие на влагалище и матку, способствуя развитию доброкачественной и злокачественной патологии матки, особенно у женщин в постменопаузальном возрасте с раком молочной железы [31][32][33]. Риск рака эндометрия связан не с суточной дозой тамоксифена, а с более длительным (5-10 лет) [32] и накопительным его исполь-зованием [34].…”

Roles of estrogen receptor α in endometrial carcinoma (Review)

“…ERα is used as a therapeutic target for EC, and several drugs targeting ERα are currently being applied for the treatment of EC. In addition, ERα has a role as a good prognostic indicator for EC (Table IV) (12,115).…”

“…For example, an early age at menarche, a late age at menopause and ovarian tumors all increase the cumulative exposure of the endometrium to E2, thereby increasing the risk of EC (11). In addition, tamoxifen, which is commonly used in the treatment of breast cancer, can act as an ER agonist and cause endometrial hyperplasia, polyps, cancer or sarcoma in the long term after surgery (12). Regarding type II, there is as yet no consensus on the etiology of precancerous lesions, but p53 mutations and the abnormal amplification of HER-2 are the main causes that are currently known (13).…”