肥胖无症状绝经前后乳腺癌患者的子宫内膜息肉：有必要筛查吗？

Endometrial polyps in obese asymptomatic pre and postmenopausal patients with breast cancer: is screening necessary?

机构信息

Department of Obstetrics and Gynecology, University Hospital of Puerto Real, Faculty of Medicine, University of Cádiz, Spain.

出版信息

Gynecol Oncol. 2014 Apr;133(1):56-62. doi: 10.1016/j.ygyno.2013.12.029.

DOI:10.1016/j.ygyno.2013.12.029

PMID:24680592

Abstract

OBJECTIVE

To evaluate the prevalence of endometrial polyps in obese asymptomatic pre and postmenopausal patients with breast cancer and to know if a baseline pretamoxifen endometrial assessment should be taken into consideration in these women at high risk.

METHODS

A cross-sectional study was carried out with 201 women with breast cancer. A diagnostic hysteroscopy was performed in all women. All formations suspected as polyps were removed. The prevalence of endometrial polyps was analyzed in all patients (n=182) and in premenopausal (n=49) and postmenopausal (n=118) women with estrogen receptor (ER) positive breast cancer (BC) according to their body mass index (BMI) and other risk factors.

RESULTS

Hysteroscopic evaluation was possible in 182 cases (90.5%). Of the total of women, 160 (87.9%) were ER(+)BC patients, 133 (73.1%) postmenopausal women and 41.5% were obese (BMI≥30kg/m(2)). Endometrial polyps were found in 52 cases (28.5%) (3 cases of simple hyperplasia harbored within a polyp). In premenopausal patients with ER(+)BC, there were no statistical differences in endometrial polyps according to their BMI (22.3% in non-obese women vs 31.7% in obese) while in all patients (26.4% in non-obese vs 44.0% in obese) and in postmenopausal women with ER(+)BC (25.9% in non-obese vs 48.6% in obese) there were statistical differences. In all women the relative risk (RR) of endometrial polyps in obese patients was 2.24 (1.01-4.83), in obese postmenopausal women with ER(+)BC was 2.75 (1.01-7.40) and in obese premenopausal patients with ER(+)BC was 1.42 (0.80-3.29).

CONCLUSIONS

Asymptomatic women with breast cancer have a high prevalence of baseline subclinical endometrial polyps and it is very high in obese postmenopausal patients with estrogen receptor positive breast cancer. Therefore, there may be a future role for baseline pretamoxifen screening of some sort for the obese asymptomatic postmenopausal patient, especially if they are elderly and ER positive.

摘要

目的

评估肥胖无症状绝经前和绝经后乳腺癌患者中子宫内膜息肉的患病率，并探讨在这些高危女性中是否应考虑在他莫昔芬治疗前进行子宫内膜评估。

方法

对 201 例乳腺癌患者进行了一项横断面研究。所有患者均行诊断性宫腔镜检查。所有疑似息肉的病变均被切除。根据体重指数（BMI）和其他危险因素，分析所有患者（n=182）和绝经后雌激素受体（ER）阳性乳腺癌（BC）的绝经前（n=49）和绝经后（n=118）患者中子宫内膜息肉的患病率。

结果

182 例（90.5%）患者可行宫腔镜检查。所有患者中，160 例（87.9%）为 ER(+)BC 患者，133 例（73.1%）为绝经后妇女，41.5%为肥胖（BMI≥30kg/m(2)）。52 例（28.5%）患者发现子宫内膜息肉（3 例息肉内存在单纯性增生）。在 ER(+)BC 的绝经前患者中，根据 BMI，子宫内膜息肉的发生率无统计学差异（非肥胖组为 22.3%，肥胖组为 31.7%），但在所有患者（非肥胖组为 26.4%，肥胖组为 44.0%）和绝经后 ER(+)BC 患者（非肥胖组为 25.9%，肥胖组为 48.6%）中，差异有统计学意义。所有女性中，肥胖患者子宫内膜息肉的相对风险（RR）为 2.24（1.01-4.83），肥胖绝经后 ER(+)BC 患者为 2.75（1.01-7.40），肥胖绝经前 ER(+)BC 患者为 1.42（0.80-3.29）。