The tamoxifen controversy.

PURPOSE/OBJECTIVES: To conduct a comprehensive review of the controversies associated with tamoxifen, specifically the increased incidence of benign conditions of the uterus and endometrial cancer, tamoxifen's common side effects, the Breast Cancer Prevention Trial, and screening recommendations for endometrial cancer.

DATA SOURCES

Published articles, bulletins, books, and monographs.

DATA SYNTHESIS

Although tamoxifen works as an antiestrogen in breast tissue, it has estrogenic properties that affect bones, the cardiovascular system, the endometrium, and possibly the liver. Approximately 2 out of every 1,000 women with breast cancer receiving tamoxifen are at risk for developing endometrial cancer at a rate two to three times greater than the risk for the general population. This increased risk could have a physical and psychological impact on the thousands of women currently receiving the drug.

CONCLUSIONS

The net benefit of a 40% reduction in contralateral breast cancer outweighs the risk of developing endometrial cancer. Additional research should include a quality-of-life study of endometrial cancer risk versus emotional reaction to preventing breast cancer.

IMPLICATIONS FOR NURSING PRACTICE

Nurses are in an ideal position, as patient educators, to teach women receiving tamoxifen to recognize symptoms of endometrial cancer and report uterine abnormalities.