{"paper_id":"a1a8b367-847f-4863-a32b-d87d89c83e30","body_text":"https://doi.org/10.61873/OEFM7580                    pISSN 1011-6583 • eISSN 2945-1922                    https://pharmakonpress.gr/en \n \nREVIEW OF CLINICAL PHARMACOLOGY AND PHARMACOKINETICS, INTERNATIONAL EDITION   38 (1): 7-9 (2024) \nReceived: 4 February 2024 | Reviewed: 19 February 2024 | Accepted: 20 February 2024 | Published: 22 February 2024 \n \n \nOpen Access | Editorial \n \n \nShould ultrasound assessment of the endometrium be \nnecessary in patients treated with Tamoxifen? \n \nGeorgios Iatrakis1 , Stefanos Zervoudis1,2 , Angeliki Sarella1 , Panagiotis \nTsikouras3 , Minas Paschopoulos5 , Myrsini Balafouta1 , Panagiotis \nPeitsidis 4,*  \n \n1 University of West Attica, Athens, Greece\n \n2 Rea Hospital, Athens, Greece\n \n3 University Hospital of Alexandroupolis, Greece\n \n4 Helena Venizelou Hospital Athens, Greece \n5 University of Ioannina, Greece \n  \n*Corresponding author \nDr. Panagiotis Peitsidis PhD Msc, Obstetrician Gynecologist, Helena Venizelou Hospital Athens, Greece \nEmail: peitsidiobgyn@gmail.com \n \n \n \nAbstract \nTamoxifen is a nonsteroidal selective estrogen receptor modulator that is used mainly for adjuvant treatment of \nestrogen receptor-positive breast cancer. However, tamoxifen, due to its estrogen-mimicking effects, has been linked \nto various uterine conditions including menstrual irregularities, and endometrial c ancer. Considering that in women \ntaking tamoxifen, ultrasonographical endometrial thickness can be increased without an underlying pathology and \nthat the tamoxifen induces only an extra endometrial cancer in 1 per 1000 women per year of use, patients undergoing \ntamoxifen treatment don't typically undergo regular examinations of the endometrium, including ultrasonography. \nRoutine ultrasonographic screening for endometrial lesions could result in excessive intervention for non-symptomatic \nendometrial conditio ns, undue stress, and might even negatively affect patients' adherence to tamoxifen therapy, \nwhich is crucial for reducing breast cancer recurrence and mortality. Nevertheless, if any unusual bleeding arises, an \nendometrial evaluation is necessary. \n \nKEYWORDS   \ntamoxifen, endometrial thickness, ultrasound, breast cancer \n  \n \n \nPublisher note : PHARMAKON-Press stays neutral with \nregard to jurisdictional claims in published maps and institutional \naffiliations. \n \n \n \nCopyright: © 2024 by the authors.  \nLicensee PHARMAKON-Press, Athens, Greece. \nThis is an open access article published under the terms \nand conditions of the Creative Commons Attribution (CC BY) \nlicense. \n \nTamoxifen is a nonsteroidal selective estrogen \nreceptor modulator that is used mainly for adju-\nvant treatment of estrogen receptor -positive \nbreast cancers in premenopausal women [1] and \nas chemoprevention in patients at increased \nrisk for breast cancer [2].  \nIn premenopausal patients, the effect of ta -\nmoxifen on the hypothalamic -pituitary-ovarian \naxis is similar to clomiphene, increasing follicle-\nstimulating hormone (FSH) and estradiol levels, \nand in those women having abnormal uterine \nbleeding, up to 23 percent will be found to have \nunderlying (benign) endometrial pathology. In \npostmenopausal women, tamoxifen exerts a \nstrong estrogenic effect that can stimulate en -\ndometrial proliferation and DNA damage [2].  \nHow to cite this article: Iatrakis G., Zervoudis S., Sarella \nA., Tsikouras P., Paschopoulos M., Balafouta M., Peitsidis \nP. Should ultrasound assessment of the endometrium be \nnecessary in patients treated with Tamoxifen? Rev. Clin. \nPharmacol. Pharmacokinet. Int. Ed. 38 (1): 7-9 (2024).  \nhttps://doi.org/10.61873/OEFM7580 \n\n8     REVIEW OF CLINICAL PHARMACOLOGY AND PHARMACOKINETICS, INTERNATIONAL EDITION  2024   \n \nUnlike raloxifene, tamoxifen has been linked \nto various uterine conditions such as menstrual \nirregularities, blood clots, uterine sarcoma, uter-\nine carcinosarcoma [2], and endometrial thick -\nening, fibroids, polyps, and endometrial cancer \ndue to its estrogen -mimicking effects [3]. How-\never, tamoxifen induces only an extra endome-\ntrial can cer in 1 per 1000 women per year of \nuse, with en dometrial cancer being extremely \nrare in asympto matic premenopausal patients \n[4]. Thus, patients under going tamoxifen treat -\nment don't typically un dergo regular examina -\ntions of the endometrium, including ultrasonog-\nraphy [5] and the American College of Obstetri-\ncians and Gynecologists (ACOG) endorses \nagainst screening asymptomatic patients on ta -\nmoxifen for endometrial cancer [6]. On the con-\ntrary, some authors recommend the assess -\nment of thickened endometrium in tamoxifen \ntherapy [7]. \nTamoxifen typically induces sub-endometrial \ncysts at ultrasonography which correspond to \ncystically dilated endometrial glands at histology \n[8], although an atrophic endometrium could be \ndiscovered in some cases. Furthermore, tamoxifen \nis associated with endometrial polyps (ultraso-\nnographically discovered) which are not precur-\nsors of malignancy, and a large proportion of ta-\nmoxifen users, without endometrial pathology at \nthe start, will develop such subclinical lesions [8]. \nNevertheless, if any unusual bleeding arises, an \nendometrial evaluation is necessary due to the \nmarginally heightened risk of endometrial cancer \nassociated with ta moxifen. More than half of \npremenopausal patients and up to a quarter of \npostmenopausal patients on tamoxifen thera py \nexperience abnormal uterine bleeding [9]. This \ncondition necessitates further investigation. Endo-\nmetrial biopsy or Hysteroscopy with curettage is \nimperative in most cases [7]. Furthermore, the \nfirst procedure has generally replaced the need \nfor diagnostic dilation and curettage.  \nThe point is to be sure that there is no endo-\nmetrial cancer [10]. Nevertheless, the presence \nof spotting as a clinical symptom is crucial to pro-\npose more investigation. One difficulty of diagno-\nsis that could hide an endometrial cancer occurs \nin patients with very tight or closed cervix [11]. \nAs a conclusion, conducting routine ultraso-\nnographic screenings for endometrial lesions in \nasymptomatic patients on tamoxifen could result \nin excessive intervention for non -symptomatic \nendometrial conditions, undue stress, and might \neven negatively affect patients' adherence to ta-\nmoxifen therapy, which is crucial for reducing \nbreast cancer recurrence and mortality. \n \nCONFLICT OF INTEREST STATEMENT \nThe authors declare no conflicts of interest. \n \nREFERENCES \n \n1. 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