Risk factors for endometrial pathology in women with breast cancer and tamoxifen treatment Abstract

Miranda JM SHUM
Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong

Objectives: To identify risk factors for development of endometrial pathology in both premenopausal and postmenopausal women who received tamoxifen treatment for breast cancer.
Methods: Medical records of women who had breast cancer and tamoxifen treatment and received endometrial sampling at Queen Elizabeth Hospital between 1 January 2017 and 31 December 2020 were retrospectively reviewed. Histology of the endometrial tissue was classified as normal, endometrial polyp, endometrial hyperplasia (with or without atypia), and endometrial cancer. Women with normal endometrium were compared with women with endometrial cancer/hyperplasia or women with endometrial polyp. Risk factors of endometrial pathology were identified through univariate and multivariate analyses.
Results: 249 women (mean age, 50.8 years) were included. Of 249 endometrial samplings, 169 (67.9%) showed normal endometrium, 71 (28.5%) showed endometrial polyp, 5 (2.0%) showed endometrial hyperplasia, and 4 (1.6%) showed endometrial cancer. In univariate analysis, endometrial cancer/hyperplasia was associated with lower parity, longer duration of menopause, longer duration of breast cancer diagnosis, longer duration of tamoxifen treatment, completion of tamoxifen therapy, longer duration of tamoxifen cessation, endometrial thickness of ≥5 mm, and endometrial thickness of ≥9 mm, whereas endometrial polyp was associated with older age, postmenopausal status, abnormal endometrium on ultrasound, endometrial thickness of ≥5 mm, and endometrial thickness of ≥9 mm. In multivariate analysis, risk factors for endometrial cancer/hyperplasia were nulliparity (odds ratio [OR]=8.7, p=0.035), duration of breast cancer diagnosis >10 years (OR=11.6, p=0.019), and endometrial thickness ≥9 mm (OR=11.9, p=0.031), whereas the risk factor for endometrial polyp was endometrial thickness ≥9 mm (OR=5.3, p<0.001).
Conclusion: In women who had breast cancer and tamoxifen treatment, nulliparity, a history of breast cancer >10 years earlier, and endometrium thickness of ≥9 mm are independent risk factors for endometrial cancer/ hyperplasia. Early hysteroscopic assessment should be arranged for these patients, especially when they presented with abnormal uterine bleeding.
Hong Kong J Gynaecol Obstet Midwifery 2022; 22(2):107-13
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