SCREENING BY ULTRASONOGRAPHY FOR ENDOMETRIAL CARCINOMA IN POSTMENOPAUSAL BREAST-CANCER PATIENTS UNDER ADJUVANT TAMOXIFEN

Seven-hundred thirty-seven asymptomatic postmenopausal breast cancer p atients under long-term adjuvant tamoxifen therapy (average, 50 months ) were screened by endometrial ultrasonography. Abnormal endometrial t hickness (6 mm or larger) was observed in 209 subjects and was signifi cantly associated with patients' age and duration of tamoxifen therapy . Outpatient endometrial biopsy was recommended in presence of abnorma l endometrial thickness: 25 subjects refused biopsy, whereas 76 were n ot biopsied because of cervical stenosis and were followed-up by repea t sonography. Of 108 biopsied subjects, one case of endometrial carcin oma (as expected in the screened cohort according to age-specific inci dence rates provided by the regional cancer registry) and one case of endometrial hyperplasia were histologically confirmed, whereas endomet rial atrophy was evident in the remaining cases. No other case of endo metrial carcinoma has been recorded so far in the studied cohort accor ding to the local cancer registry and no further change of the endomet rium has been observed at sonographic follow-up. The cohort will be fo llowed-up by repeat annual endometrial sonography. Thus far, we did no t find evidence of increased prevalence of endometrial pathology (carc inoma or hyperplasia) which may be ascribed to tamoxifen therapy. The apparent increase in endometrial thickness observed at sonography migh t be explained by tamoxifen-induced changes of endometrial stroma and myometrium, misinterpreted as hyperplasia, while causing no real epith elial disease. (C) 1996 Academic Press, Inc.