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#Grand Rounds

Is Tamoxifen a Risk Factor for Endometrial Cancer in Women with Endometrial Polyps?

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BACKGROUND AND PURPOSE:

  • Association between tamoxifen (a SERM) and endometrial cancer is well known
  • The relationship between tamoxifen use and cancer specifically in women who present with polyps is still unclear
  • Yela et al. (Menopause, 2019) investigated whether tamoxifen is a cancer risk factor in women with confirmed endometrial polyps

METHODS:

  • Retrospective cohort study
  • Participants
    • Women undergoing endometrial polypectomy (via hysteroscopy)
  • Polyps visualized and confirmed on histology
  • Groups
    • Tamoxifen use
    • No tamoxifen use
  • Data analysis
    • Univariate and multivariate regression analyses
    • Variables assessed aside from tamoxifen use: Duration of tamoxifen use | Age | BMI | Vaginal bleeding | Menopausal status | Parity | BP | Diabetes mellitus | Polyp size | Smoking status | Hormonal therapy | Breast cancer diagnosis
    • Estimation of prevalence ratio (PR) to analyze factors related to endometrial cancer
  • Primary outcome
    • Endometrial cancer prevalence

RESULTS:

  • 675 participants
    • Tamoxifen use: n=169 | No tamoxifen use: n=506
    • Mean tamoxifen use duration: 2.8 years
  • No difference in cancer occurrence between the two groups (P = 0.083)
    • Tamoxifen use: 4.14%
    • No tamoxifen use: 8.1%
  • Following multivariate analysis, tamoxifen was still not a risk factor for endometrial cancer vs nonuse (P = 0.101)
    • Endometrial cancer: PR 0.51 (95% CI, 0.23 to 1.14)
  • Factors that increased prevalence of malignancy in the no tamoxifen group included
    • Abnormal uterine bleeding: PR 3.9 (95% CI, 2.08 to 7.29; P < 0.001)
    • Age >60 years: PR 2.1 (95% CI, 1.12 to 3.93; P = 0.021)
    • Nulliparous: PR 3.13 (95% CI, 1.55 to 6.35; P = 0.002)
  • Factors that increased prevalence of malignancy in the tamoxifen group included
    • Age >60 years: PR 7.85 (95% CI, 1.05 to 58.87; P = 0.006)
    • Nulliparous: PR 8.36 (95% CI, 2.32 to 30.11; P < 0.001)
  • Breast cancer was not a risk factor for increased endometrial cancer prevalence

CONCLUSION:

  • Tamoxifen does not appear to be an independent risk factor for endometrial cancer in women undergoing hysteroscopic polypectomy  
  • In tamoxifen users
    • Age >60 years increased the prevalence of endometrial cancer by almost 8 times and being nulliparous increased the risk by almost 8.4 times
  • Authors acknowledge that other studies have found a higher incidence of malignancy in women with polyps who are being treated with tamoxifen
    • Possible explanations: Present study has larger ‘n’ | Average tamoxifen duration in the present cohort was less than 3 years while patients were on tamoxifen for longer duration in other studies

Learn More – Primary Sources:

Tamoxifen use as a malignancy risk factor in postmenopausal women with endometrial polyps

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Related ObG Topics:

Tamoxifen Therapy and Uterine Cancer Risk: The Data and Clinical Implications
Endometrial Cancer: The Basics
Breast Cancer Recurrence Risks Following Endocrine Therapy – 20 Years Out
Endometrial Polyps

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