Annals of Oncology Advance Access originally published online on May 4, 2005
Annals of Oncology 2005 16(8):1402; doi:10.1093/annonc/mdi236
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© 2005 European Society for Medical Oncology
Letter to the Editor |
Response to "Third generation aromatase inhibitors may prevent endometrial growth and reverse tamoxifen-induced uterine changes in postmenopausal breast cancer patients", by L. Morales et al. (Ann Oncol 2005; 16: 70–74)
I read with great interest the article by Morales et al. [1
], describing a potential reversal of tamoxifen-induced uterine changes, by third-generation aromatase inhibitors. The authors found that aromatase inhibitors can decrease endometrial thickness (and uterine volume) in patients previously treated with tamoxifen for 3 months.
However, it may well be that the decrement of endometrial thickness was mainly due to discontinuation of tamoxifen treatment, regardless of the administration of aromatase inhibitors, as it has been shown that endometrial thickness is significantly reduced within 6 months following tamoxifen discontinuation, and remains constantly low thereafter [2, 3].
A second issue is the endometrial pathologies identified in the tamoxifen-treated patients; the authors mentioned that endometrial polyps were identified in some of these patients, exclusively diagnosed by transvaginal ultrasonography [1]. However, it is usually impossible to distinguish between endometrial polyps and subendometrial fibroids without their direct visualization through hysteroscopy. Thus, the shrinkage of these polyps may well be a decrease in size of subendometrial fibroids rather than that of a polypoid tissue.
Department of Obstetrics and Gynecology, Meir Hospital-Sapir Medical Center, Kfar-Saba, Israel (E-mail: bensonm{at}clalit.org.il)
References
1. Morales L, Timmerman D, Neven P et al. Third generation aromatase inhibitors may prevent endometrial growth and reverse tamoxifen-induced uterine changes in postmenopausal breast cancer patients. Ann Oncol 2005; 16: 70–74.
2. Cohen I, Beyth Y, Azaria R et al. Ultrasonographic measurement of endometrial changes following discontinuation of tamoxifen treatment in postmenopausal breast cancer patients. Br J Obstet Gynecol 2000; 107: 1083–1087.
3. Gerber B, Krause A, Muller H et al. Effects of adjuvant tamoxifen on the endometrium in postmenopausal women with breast cancer: A prospective long-term study using tranvaginal ultrasound. J Clin Oncol 2000; 18: 3464–3470.
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