Comparative characteristics of tamoxifen-associated endometrial pathology in postmenopause
Authors:   Ivanovo State Medical University, Smirnova A.V. ,   8 Sheremetevsky Prospect, Ivanovo, Russian Federation,   Ivanovo Scientific-Research Institute named after V.N. Gorodkov; Ivanovo, Russian Federation, Malyshkina A.I. ,   Ivanovo State Medical University; Ivanovo, Russian Federation,   Ivanovo Scientific-Research Institute named after V.N. Gorodkov; 20 Pobeda Str., Ivanovo, Russian Federation, Gerasimov A.M. ,   Ivanovo State Medical University; Ivanovo, Russian Federation
Published: November 2024

Resume Breast cancer (BC) occupies the leading place in terms of the frequency of occurrence among oncological diseases in women all over the world. The drug of choice in adjuvant therapy of hormone-sensitive breast cancer is a selective estrogen receptor modulator — tamoxifen. At the same time, its use is known to be a risk factor for endometrial cancer. Aim. To compare the structure of endometrial pathology in postmenopausal patients taking and not taking tamoxifen. Design. Cohort retrospective randomized study. Materials and methods. A retrospective analysis of the medical records of 60 women was carried out. The main group included 30 patients who took tamoxifen, the comparison group consisted of 30 women who did not receive it and were admitted for examination due to endometrial pathology according to ultrasound examination (ultrasound). All patients underwent general clinical examination, transvaginal ultrasound and hysteroscopy with separate diagnostic curettage. Results. The analysis of extragenital pathology revealed that hypertension took the first place in both groups; obesity of varying severity and diabetes mellitus occurred almost equally in patients who took and did not take tamoxifen. In the main group, the average value of the median uterine complex (M-echo) by ultrasound in women without spotting was 13.7 ± 4.2 mm, and in their presence — 15.4 ± 1.2 mm (p > 0.05). In the group of patients who did not take tamoxifen, the average value of M-echo on ultrasound without clinical manifestations was 10.2 ± 1.0 mm and 12 ± 2.2 mm with bloody discharge. According to the histological examination of endometrial scrapings, more than half of the patients in the main group were diagnosed with only atrophic endometrium, which is statistically significantly more often than in the group without tamoxifen (16 (53.3%) vs. 7 (23.3%), p < 0.05). A third of women in both groups had glandular fibrotic endometrial polyps on the background of atrophic endometrium, and with almost the same frequency (10 (33.3%) vs. 11 (36.7%), p > 0.05). Statistically significantly less common endometrial hyperplasia without atypia was diagnosed in the main group (only in 2 (6.7%) versus 10 (33.3%), p < 0.05). Endometrial adenocarcinoma was detected more often in the group without tamoxifen, but without statistical significance (1 (3.3%) vs. 2 (6.7%), p > 0.05) and in symptomatic patients with spotting. Conclusion. In patients taking tamoxifen as adjuvant therapy for breast cancer, in more than half of the cases (53.3%), thickening of the endometrium by ultrasound examination without changing the state of the endometrium according to histological examination. Among the concomitant extragenital diseases, hypertension, obesity and diabetes mellitus occupy a leading place, which form the basis of the metabolic syndrome. Key words: tamoxifen, endometrial hyperplasia, M-echo, breast cancer, endometrial cancer.