HORMONAL MANIPULATION AND GYNECOLOGICAL CANCER - THE TAMOXIFEN DILEMMA

Tamoxifen has a well established place in the adjuvant therapy of prim ary carcinoma of the breast. Its effects on breast cancer cells are bo th anti-oestrogenic and non-oestrogen-receptor mediated. Tamoxifen has oestrogenic effects on non-breast tissues such as liver, bone, the ca rdiovascular system and the urogenital tract. The effect on the endome trium is to increase the incidence of polyps, hyperplasia and carcinom a. Again, non-oestrogen receptor-mediated actions may be involved. Wit h more widespread use of tamoxifen now being advocated, for instance i n the primary prevention of breast cancer, careful assessment of benef it and risk is required.