Barakat R R
Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, USA.
Oncology (Williston Park). 1997 Feb;11(2 Suppl 1):35-7.
For nearly 20 years, tamoxifen has been successfully used in the management of breast cancer. Tamoxifen is a mixed estrogen agonist/antagonist that has a proliferative effect on the endometrium. The drug has been associated with a higher percentage of endometrial polyps and hyperplasia than in control patients as well as slightly increased risk of endometrial cancer. Although patients need to undergo annual gynecologic exams and abnormal vaginal bleeding needs to be aggressively followed up, the utility of routine gynecologic screening of tamoxifen patients has not been established and requires further study. Transvaginal sonography is a useful tool for detecting endometrial proliferation; however, an appropriate cut-off point for further intervention must be established. A cut-off point that is too low for abnormal endometrial thickness would result in a large number of unnecessary endometrial biopsies. Routine office endometrial biopsy needs further study as a screening method for breast cancer patients on tamoxifen.
近20年来，他莫昔芬已成功用于乳腺癌的治疗。他莫昔芬是一种雌激素混合激动剂/拮抗剂，对子宫内膜有增殖作用。与对照患者相比，该药物与更高比例的子宫内膜息肉和增生相关，同时子宫内膜癌风险略有增加。尽管患者需要每年接受妇科检查，且需要对异常阴道出血进行积极随访，但对服用他莫昔芬的患者进行常规妇科筛查的效用尚未确定，需要进一步研究。经阴道超声检查是检测子宫内膜增生的有用工具；然而，必须确定进一步干预的合适临界点。对于异常子宫内膜厚度而言，临界点设置过低会导致大量不必要的子宫内膜活检。常规门诊子宫内膜活检作为服用他莫昔芬的乳腺癌患者的一种筛查方法，还需要进一步研究。
