Hormonal manipulation and gynaecological cancer: the tamoxifen dilemma

Tamoxifen has a well established place in the adjuvant therapy of primary carcinoma of the breast. Its effects on breast cancer cells are both anti-oestrogenic and non-oestrogen-receptor mediated. Tamoxifen has oestrogenic effects on non-breast tissues such as liver, bone, the cardiovascular system and the urogenital tract. The effect on the endometrium is to increase the incidence of polyps, hyperplasia and carcinoma. Again, non-oestrogen receptor-mediated actions may be involved. With more widespread use of tamoxifen now being advocated, for instance in the primary prevention of breast cancer, careful assessment of benefit and risk is required.