Endometrial Surveillance Outcomes for a Cohort of Breast Cancer Patients Treated with Tamoxifen
MS McLemore, A Malpica. UT MD Anderson Cancer Center, Houston, TX
Background: Hormone therapy with tamoxifen for breast carcinoma (CA) is known to increase risk for endometrial cancer & polyps. However, only a few studies have evaluated these risks in tamoxifen patients (pts) undergoing regular endometrial surveillance. In this study, we present the outcomes of a cohort of breast cancer pts treated with tamoxifen who have been followed with serial endometrial sampling at a single institution.
Design: From 1998-2008, a cohort of 75 breast cancer pts treated with tamoxifen & evaluated with baseline endometrial biopsy was identified. Clinical follow-up was obtained for all pts. In cases where additional endometrial sampling was available, the diagnostic results were extracted from pathology reports.
Results: 81% of pts were evaluated by serial endometrial biopsies/curettings, & 19% underwent biopsy & eventual hysterectomy. The mean age was 50 years. 7% of pts were black, 9% Asian, 12% Hispanic, & 72% white. 69% of pts were treated for invasive ductal CA, 11% for invasive lobular CA, & 4% for mixed ductal & lobular CA; two pts were treated with tamoxifen for mucinous CA, & one for tubular CA. 4% of pts developed ductal CA in situ, & 3% had lobular CA in situ; 5% of pts received tamoxifen as chemoprevention for increased breast CA risk. In addition to tamoxifen, 39% of pts were treated with chemoradiation, 21% with chemotherapy, & 17% with radiation; 23% of pts received none. The mean duration of tamoxifen treatment was 3.6 years, & the mean follow-up duration was 3 years (range: 1 mo-9 years). Over the course of follow-up, 40% of pts maintained benign endometrium, 5% had inactive endometrium, & 4% showed disordered proliferative endometrium; one pt had insufficient endometrial tissue on her last biopsy. 39% of pts developed an endometrial polyp, & 7% developed a lower uterine segment polyp. 4% of pts showed complex hyperplasia without atypia, & 3% showed complex hyperplasia with atypia. One pt (1.3%) developed uterine serous CA in an endometrial polyp, & one (1.3%) developed well-differentiated endometrioid adenocarcinoma in an endometrial polyp. 18% of pts (8/45) showed an endocervical polyp on cervical biopsy with available results; 9% showed microglandular hyperplasia.
Conclusions: Although an endometrial polyp was the most common abnormality identified among pts, the risks for hyperplasia with atypia & for carcinoma while on tamoxifen remain real. Ongoing endometrial surveillance is warranted in breast cancer pts during treatment with tamoxifen. In addition, these pts can develop endocervical polyps & microglandular hyperplasia.
Category: Gynecologic & Obstetrics
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 118, Wednesday Morning