© 2005 European Society for Medical Oncology
Original article |
Third generation aromatase inhibitors may prevent endometrial growth and reverse tamoxifen-induced uterine changes in postmenopausal breast cancer patients
1 Departments of Medical Oncology, 2 Obstetrics and Gynecology, 3 Surgery, 4 Radiation Oncology, 5 Multidisciplinary Breast Center, University Hospitals Leuven; 6 University Center for Statistics, 7 Department of Electrical Engineering, Catholic University of Leuven, Leuven, Belgium
* Correspondence to: Dr R. Paridaens, Department of Medical Oncology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. Tel: +32-16-34-69-00; Fax: +32-16-34-69-01; Email: robert.paridaens{at}uz.kuleuven.ac.be
Background: Tamoxifen may induce uterine abnormalities of clinical concern. Our aim was to compare early uterine changes occurring in postmenopausal breast cancer patients treated in first-line with tamoxifen or third generation aromatase inhibitors. We also assessed the effect of aromatase inhibitors on tamoxifen-induced uterine changes.
Patients and methods: Seventy-seven consecutive postmenopausal breast cancer patients scheduled to start endocrine treatment were included in this prospective study. Transvaginal ultrasonography (TVUS) was carried out before and after 3 months of therapy. No interventions were done on pre-existing asymptomatic uterine abnormalities seen on baseline sonography.
Results: After 3 months of therapy, tamoxifen significantly increased endometrial thickness and uterine volume. Additionally, tamoxifen induced endometrial cysts and polyps, and increased the size of pre-existing fibroids. In contrast, aromatase inhibitors did not stimulate endometrial growth and were not associated with endometrial pathologies seen under tamoxifen. Furthermore, aromatase inhibitors decreased endometrial thickness and uterine volume in patients previously treated with tamoxifen.
Conclusions: Our study demonstrates that tamoxifen induces uterine abnormalities from as early as 3 months of therapy. In contrast, these abnormalities are not seen in patients on aromatase inhibitors. Furthermore, our data indicate that tamoxifen therapy followed by an aromatase inhibitor may lead to a reduction in endometrial pathologies associated with tamoxifen.
Key words: aromatase inhibitors, breast cancer, endometrial thickness, SERM, tamoxifen, uterine changes
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R. Paridaens, L. Morales, P. Neven, D. Timmerman, and On behalf of all co-authors of the original articl Reply to the Letter to the Editor on "Third generation aromatase inhibitors may prevent endometrial growth and reverse tamoxifen-induced uterine changes in postmenopausal breast cancer patients", by I. Cohen Ann Oncol 2005; 16: 1399 Ann. Onc., August 1, 2005; 16(8): 1402 - 1403. [Full Text] [PDF]
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