Wright Jason D, Desai Vrunda B, Chen Ling, Burke William M, Tergas Ana I, Hou June Y, Accordino Melissa, Ananth Cande V, Neugut Alfred I, Hershman Dawn L
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY.
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT.
Am J Obstet Gynecol. 2017 Jul;217(1):59.e1-59.e12. doi: 10.1016/j.ajog.2017.03.011. Epub 2017 Mar 21.
The selective estrogen receptor modulator tamoxifen is now widely used for the treatment and prevention of breast cancer. Tamoxifen use has been associated with a variety of gynecologic problems. Despite the frequency with which hormonal therapy is used for the treatment of breast cancer, limited population-level data are available to describe the occurrence of gynecologic conditions and the use of surveillance testing in women receiving tamoxifen and aromatase inhibitors.
We performed a population-based analysis among women with breast cancer receiving hormonal therapy with tamoxifen, a drug commonly used in premenopausal and sometimes postmenopausal women, to determine the frequency of gynecologic abnormalities and use of diagnostic and surveillance testing. We compared these findings to women treated with aromatase inhibitors, agents commonly used in postmenopausal women.
The MarketScan database was used to identify women diagnosed with breast cancer from 2009 through 2013 who underwent mastectomy or lumpectomy. Women receiving tamoxifen (age <50 vs ≥50 years) were compared to women ≥50 years of age treated with aromatase inhibitors. We examined the occurrence of gynecologic symptoms and diseases (vaginal bleeding, endometrial polyps, endometrial hyperplasia, and endometrial cancer) and gynecologic procedures and interventions (transvaginal ultrasound, endometrial biopsy, hysteroscopy/dilation and curettage, and hysterectomy). Time-dependent analyses were performed to examine symptoms and testing.
A total of 75,170 women, including 15,735 (20.9%) age <50 years treated with tamoxifen, 13,827 (18.4%) age ≥50 years treated with tamoxifen, and 45,608 (60.7%) age ≥50 years treated with aromatase inhibitors were identified. The cumulative incidence of any gynecologic symptom or pathologic diagnosis during the study period was 20.2%, 12.3%, and 3.5%, respectively (P < .001), while the cumulative incidence of any gynecologic procedure or intervention during the study period was 34.2%, 20.9%, and 9.0%, respectively (P < .0001). Among women without symptoms or pathology, interventions were performed in 20.0%, 11.0%, and 6.8%, respectively (P < .0001).
Compared to women taking aromatase inhibitors, gynecologic symptoms, procedures, and pathology are higher for both premenopausal and postmenopausal women with breast cancer on tamoxifen. Increased efforts to curb use of gynecologic interventions in asymptomatic women are needed.
选择性雌激素受体调节剂他莫昔芬目前广泛用于乳腺癌的治疗和预防。使用他莫昔芬与多种妇科问题相关。尽管激素疗法常用于治疗乳腺癌，但关于接受他莫昔芬和芳香化酶抑制剂治疗的女性中妇科疾病的发生情况以及监测检查的使用情况，现有的人群水平数据有限。
我们对接受他莫昔芬激素治疗的乳腺癌女性进行了一项基于人群的分析，他莫昔芬是一种常用于绝经前女性且有时也用于绝经后女性的药物，以确定妇科异常的发生率以及诊断和监测检查的使用情况。我们将这些结果与接受芳香化酶抑制剂治疗的女性（常用于绝经后女性的药物）进行了比较。
使用MarketScan数据库识别2009年至2013年期间被诊断为乳腺癌并接受乳房切除术或肿块切除术的女性。将接受他莫昔芬治疗的女性（年龄<50岁与≥50岁）与接受芳香化酶抑制剂治疗的≥50岁女性进行比较。我们检查了妇科症状和疾病（阴道出血、子宫内膜息肉、子宫内膜增生和子宫内膜癌）以及妇科手术和干预措施（经阴道超声、子宫内膜活检、宫腔镜检查/刮宫术和子宫切除术）。进行了时间依赖性分析以检查症状和检查情况。
共识别出75170名女性，其中15735名（20.9%）年龄<50岁接受他莫昔芬治疗，13827名（18.4%）年龄≥50岁接受他莫昔芬治疗，45608名（60.7%）年龄≥50岁接受芳香化酶抑制剂治疗。研究期间任何妇科症状或病理诊断的累积发生率分别为20.2%、12.3%和3.5%（P<.001），而研究期间任何妇科手术或干预措施的累积发生率分别为34.2%、20.9%和9.0%（P<.0001）。在无症状或无病理改变的女性中，分别有20.0%、11.0%和6.8%的女性接受了干预措施（P<.0001）。
与服用芳香化酶抑制剂的女性相比，接受他莫昔芬治疗的绝经前和绝经后乳腺癌女性的妇科症状、手术和病理情况更多。需要加大力度减少无症状女性的妇科干预措施的使用。
