Effects of chemotherapy and tamoxifen on cervical and vaginal smears in bone marrow transplant recipients

OBJECTIVE: To clarify the importance of squamous and glandular atypia in th e genital tracts of women undergoing high-dose chemotherapy and receiving t amoxifen. STUDY DESIGN: The pathology records of 769 female bone marrow transplant re cipients from a five-year period at Duke University Medical Center were rev iewed. One hundred fifteen cervicovaginal smears from 78 patients were avai lable for evaluation; of these, 85 smears from 61 patients were selected. O nly cases from patients with a complete medical history, including menopaus al status and therapeutic regimen, were included in this study. Forty-five cases were from patients treated with chemotherapy alone, and 40 were from patients treated with a combination of chemotherapy and tamoxifen. RESULTS: A normal cellular pattern was the most common finding, Reactive ce llular changes associated with therapy effect were identified in 21% of cas es. In patients treated with chemotherapy alone, an atrophic smear pattern in a premenopausal woman was identified in 27% of cases. Squamous epithelia l cell abnormalities were identified in approximately the same proportion o f patients whether they received chemotherapy alone ol with tamoxifen. Glan dular changes were uncommon. CONCLUSION: The most common finding was a nor;mal smear pattern. An atrophi c smear was more commonly found in patients treated with chemotherapy alone than in those treated with both chemotherapy and tamoxifen. Squamous epith elial cell abnormalities are most probably independent of treatment effect. Glandular changes were rare in patients treated with chemotherapy, alone o r in combination with tamoxifen.