EFFECTS OF TAMOXIFEN ON THE CYTOLOGY OF THE UTERINE CERVIX IN BREAST-CANCER PATIENTS

Tamoxifen, a nonsteroidal antiestrogen, is the endocrine therapy of ch oice for all stages of breast cancer: Because tamoxifen is well tolera ted and has minimal side effects, it is currently being evaluated in l arge scale trials as a chemopreventive agent for women at risk for dev eloping breast cancer The potential adverse effects of tamoxifen, spec ifically the development of proliferative lesions of the endometrium, coupled with the prospect of its wider use, places new emphasis on rec ognizing tamoxifen-associated histologic and cytologic changes in the female genital tract. The current study evaluated cervical smears from 52 breast cancer patients treated with tamoxifen compared with 21 sme ars from breast cancer patients who had not received tamoxifen. Cytolo gic diagnoses were classified according to the Bethesda system. The pr esence of blood, inflammation, and hormonal effect were also assessed. No squamous intraepithelial lesions were identified. A total of 21 of 38 smears (55%) from patients receiving tamoxifen alone and II of 14 smears (78%) from women who received tamoxifen in combination with adj uvant cytotoxic chemotherapy showed atypias compared with only 6 of th e 21 breast cancer patients (28%) who did not have hormonal therapy Th e number of smears showing atypia was equally divided into changes int erpreted as benign reactive and atypical squamous cells of undetermine d significance (ASCUS). Of the 19 patients whose smears were classifie d as ASCUS, 13 patients had a subsequent cervical biopsy and none show ed dysplasia or diagnostic human papilloma virus changes. Tamoxifen th erapy was not associated with an increase in the presence of blood or inflammation, and no discernible alteration in the hormonal state was seen in the cervical smears. We conclude that the use of tamoxifen may be associated with benign squamous atypia in cervical smears and that the atypia is not associated with intraepithelial lesions. (C) 1998 W iley-Liss, Inc.