While investigative efforts continue into antiestrogens such as raloxifene, attention is focused on endometrial cancer screening in women taking tamoxifen. One approach to screening for endometrial cancer in women taking tamoxifen would be to perform an endometrial biopsy only in the presence of irregular vaginal bleeding. While this approach is undoubtedly the most cost-effective, it does not take into consideration the understandably high level of anxiety maintained by these patients. Presently, I am unable to state the incidence of endometrial carcinoma in the absence of irregular vaginal bleeding for women being treated with tamoxifen. Because of this, I discuss annual endometrial biopsy as a screening option for my patients, including the risks associated with that procedure.
Pelvic ultrasound is also reasonable.
However, given that endometrial thickening is a common ultrasound finding in women taking tamoxifen, many of these patients will require an endometrial biopsy at that point, altering the cost-benefit analysis even further. In all cases, a lengthy discussion must be held with each individual patient, reviewing the facts and possible options. Ultimately, in women who have been prescribed tamoxifen, the decision of whether to screen for endometrial carcinoma and how to screen is between the patient and her physician. Hopefully, with new antiestrogens on the horizon, we'll be able to provide the same treatment or protection against breast cancer, without an increased risk for endometrial cancer. Reports on treatment options, clinical trials, coping skills and early detection strategies.