Variation in endometrial thickening in women with amenorrhea on tamoxifen

被引:28
作者
Chang, J
Powles, TJ
Ashley, SE
Iveson, T
Gregory, RK
Dowsett, H
机构
[1] Royal Marsden Hosp, Dept Comp & Stat, Med Breast Unit, Sutton SM2 5PT, Surrey, England
[2] Royal Marsden Hosp, Dept Comp & Stat, Med Breast Unit, London SW3 6JJ, England
关键词
D O I
10.1023/A:1005999008736
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Tamoxifen is reported to increase the risk of endometrial cancers mostly in postmenopausal women. In the Royal Marsden chemoprevention programme, we noted that premenopausal women at the start of tamoxifen/placebo who developed amenorrhea may be at special risk of endometrial cancer. The aim of this report was to investigate recently amenorrheic women by measuring plasma estradiol (E-2), follicular stimulating hormone (FSH), and endometrial thickness (ET) by transvaginal ultrasound (TVUS). ET readings and E-2 levels were available in the same proportion of women on tamoxifen or placebo. Women on placebo developed amenorrhea with upper limit of E-2 readings of 450 pmol/L. In both postmenopausal women and recently amenorrheic women with low E-2 (less than or equal to 450 pmol/L), tamoxifen significantly increased endometrial thickening (p < 0.0001 and < 0.005 respectively). Conversely, tamoxifen did not result in endometrial thickening in women with high E-2 (> 450 pmol/L), with a trend to lower ET readings (p = 0.07). Finally, all five women who developed endometrial cancer were premenopausal at the start of tamoxifen/placebo. Two of these five women were asymptomatic with increased ET readings (17 mm and 17 mm) and low E-2 levels (32 and 51 pmol/L). These results indicate that women who develop amenorrhea on tamoxifen may be at special risk of endometrial cancer. Tamoxifen causes endometrial thickening in amenorrheic women with low E-2 but has an opposite antiestrogenic effect in women with high E-2. We recommend that women who develop amenorrhea on tamoxifen especially in the presence of endometrial thickening, low E-2 levels, and/or gynaecological symptoms warrant further investigations.
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页码:81 / 85
页数:5
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