SPECIAL DEPARTMENTS
Authors: Marian J. Mourits, Pax H. Willemse, Elizabeth G. de Vries, Ate G. van der Zee, C.D. B. Love, J.M. Dixon, Richard R. Barakat
Journal: Journal of Clinical Oncology (2000)

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2000.18.2.446 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 10637262 Marian J. MouritsxMarian J. MouritsSearch for articles by this author , Pax H. WillemsexPax H. WillemseSearch for articles by this author , Elizabeth G. de VriesxElizabeth G. de VriesSearch for articles by this author , Ate G. van der ZeexAte G. van der ZeeSearch for articles by this author C.D. B. LovexC.D. B. LoveSearch for articles by this author , J.M. DixonxJ.M. DixonSearch for articles by this author Richard R. BarakatxRichard R. BarakatSearch for articles by this author Show More University of Groningen GroningenThe NetherlandsEdinburgh Breast Unit Western General Hospital EdinburghUnited KingdomMemorial Sloan-Kettering Cancer Center New YorkNY https://doi.org/10.1200/JCO.2000.18.2.446 First Page Full Text PDF Figures and Tables © 2000 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse01012000Response01012000Reply 1:Mourits et al indicate that based on a study of 53 patients, but with histology results from only three who underwent hysterectomy while on tamoxifen, the thickened endometrium seen in patients on TVU is due to cystically dilated glands and dense endometrial stroma. They conclude that the thickened endometrium in women with normal hysteroscopy results correlates with histologic changes within the endometrium rather than in the subendometrial or myometrial layers. We have also been interested in the histologic changes in the endometrium of women on tamoxifen and have been frustrated by our inability to satisfactorily biopsy endometrium of study patients. Therefore, we identified 134 women in the last 2 years by data linkage from the Information and Statistics Department, Trinity Park House, Edinburgh, who had a diagnosis of breast cancer and had undergone hysterectomy. Thirty-four hysterectomy specimens from women who were taking tamoxifen at the time of hysterectomy and 14 control specimens from women with a diagnosis of breast cancer who had never received tamoxifen were retrieved and assessed. All hysterectomies were performed for noncancer causes. To our knowledge, this is the first study to compare the histologic characteristics of tamoxifen-treated patients with those of an appropriate series of control patients. There were three statistically significant differences between the endometrium of tamoxifen users and controls; tamoxifen-exposed endometrium was more likely to show cystic dilation of endometrial glands, low stromal cellularity, and prominence of collagen within the stroma. This larger series confirms some of the observations of Mourits et al and indicates that the sonographic changes correlate directly with histologic changes in the endometrium.In the Edinburgh Breast Unit, a regional breast cancer unit dealing with 700 new patients diagnosed with breast cancer per year, on the basis of the results of our study and of other studies in the literature, women on tamoxifen do not undergo endometrial screening or have regular gynecologic examinations. Women are encouraged to report any abnormal bleeding or discharge promptly so that they may be appropriately investigated. This policy is consistent with the view expressed by Mourits et al that endometrial screening is not worthwhile.Reply 2:In response to Mourits et al’s letter regarding tamoxifen and endometrial screening, it would seem that we are in agreement that there is no benefit to routinely screening the endometrium in a tamoxifen-treated patient. I also agree that tamoxifen-treated patients should be instructed and encouraged to report abnormal vaginal discharge or bleeding and that endometrial sampling should be reserved to these patients. Mourits et al state that they are confused with our recommendation, however, that all women with breast cancer, whether or not they are receiving tamoxifen, should undergo annual gynecologic evaluation. In the United States, in many cases, the gynecologist serves as the primary care physician, which provides an opportunity for women to have their general physical condition evaluated and undergo comprehensive examination, including monitoring of their blood pressure and weight as well as an evaluation of other organ systems. In no way does this statement imply that annual gynecologic evaluation should include any form of endometrial sampling in asymptomatic breast cancer patients whether or not they are taking tamoxifen. I disagree with Mourits et al’s statement that the routine gynecologic evaluation may feed the anxiety of both doctors and patients. On the contrary, an annual examination may provide the patient with reassurance and a sense of well-being.