Tamoxifen Therapy and Uterine Cancer Risk: The Data and Clinical Implications
Tamoxifen, a well known SERM, is used to treat breast cancer (hormone receptor positive) because of well-documented benefits including improved disease-free survival (5-year was 38% higher than placebo) and overall survival, regardless of menopausal status. It also is used as a chemoprophylactic agent for women at high risk for breast cancer. ACOG reaffirmed their guidance on tamoxifen monitoring (2019), which includes a statement that tamoxifen use may be extended to 10 years.
Tamoxifen for Breast Cancer Treatment
Uterine Cancer Risk (NSABBP)
Within first 5 years of follow up
Average annual hazard rate of endometrial cancer:
Cumulative hazard rate: 6.3/1000
Endometrial cancers following tamoxifen therapy are
not of a different type, nor do they carry worse prognosis
Endometrial cancer is the most common gynecologic malignancy in the US and accounts for 7% of all cancers in women. Most cases are diagnosed early and can be treated with surgery alone. with surgery alone. However, there are certain cell types and clinical features (such as extrauterine spread) that are associated with a high rate of relapse following surgical and medical therapy. There are two types of endometrial cancer that vary in epidemiology, genetics, treatment, and prognosis.
Types of Endometrial Cancer
Type 1 (more common): Endometrioid
Precursor is atypical endometrial hyperplasia (or endometrial intraepithelial neoplasia)
Most cases are low grade
Generally results from unopposed, prolonged estrogen stimulation
Unopposed estrogen |Age| Obesity | Metabolic syndrome | Nulliparity | Infertility | Late menopause | Tamoxifen use | Type 2 diabetes | Hypertension | Lynch syndrome
Note: Tamoxifen risk may be related to age and is significant in women ≥50 years of age (NSABP prevention trial in high risk women)
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