TAMOXIFEN AND THE ENDOMETRIUM - FINDINGS OF PELVIC ULTRASOUND EXAMINATION AND ENDOMETRIAL BIOPSY IN ASYMPTOMATIC BREAST-CANCER PATIENTS

The need for endometrial surveillance in breast cancer patients underg oing adjuvant treatment with tamoxifen is still controversial. In this study, 164 asymptomatic breast cancer patients (110 on treatment with tamoxifen, 20 mg/day, and 54 controls) were examined with pelvic ultr asound and endometrial biopsy. No differences in ultrasound and biopsy findings were observed in the pre-and perimenopausal group between pa tients treated with tamoxifen and controls. Postmenopausal patients on tamoxifen had a significantly thicker endometrium (mean +/- SD, 7.2 /- 8.5 vs. 1.5 +/- 4.3 mm, p = 0.00002) and significantly larger uteri ne volume (mean +/- SD, 63.2 +/- 39.9 vs. 43.7 +/- 38.8 cm(3), p = 0.0 001) than controls. Fifty-four percent of patients on tamoxifen had an endometrial thickness greater than or equal to 5 mm, often with multi ple irregular sonolucencies suggesting the presence of cysts. Ultrasou nd findings, however, did not correlate with the presence of endometri al abnormalities on biopsy, and no endometrial cancer or atypical hype rplasia were found. This lack of correlation makes clues tionable the use of routine sonography in asymptomatic breast cancer patients on ta moxifen. Obtaining routine endometrial samples, on the other hand, may be difficult in some patients because of cervical stenosis or refusal . Until the benefits of endometrial surveillance will be proved, asymp tomatic patients should not be submitted routinely to ultrasound exami nation or biopsy, but encouraged to report promptly any abnormal vagin al bleeding.