Gynecologic surveillance of women on tamoxifen

To determine the gynecologic surveillance practices of Connecticut physicians regarding asymptomatic, postmenopausal women receiving tamoxifen for breast cancer management prior to and following a National Cancer Institute (NCI) directive recommending ongoing study and annual pelvic examinations.

An anonymous survey of 110 Connecticut medical oncologists, and 306 gynecologists was completed.

Sixty-three of 110 (57.3%) medical oncologists and 134 of 306 (43.8%) gynecologists responded to the survey. Prior to the NCI directive, 51 (81.0%) of the medical oncologists referred patients for annual gynecologic surveillance. A pelvic examination and Papanicolaou smear were anticipated. Following the NCI directive, 29 (46.0%) routinely expected an endometrial biopsy and 17 (27.0%) expected a pelvic ultrasound evaluation. Prior to the directive, 96 (71.6%) gynecologists recommended annual gynecologic surveillance and 35 (26.1%) recommended it semiannually. Following the directive, semiannual evaluation was recommended by 52 (38.8%). Prior to the directive, 11 gynecologists (8.2%) recommended annual endometrial biopsies and 21 (15.7%) pelvic ultrasound examinations. Following the directive these recommendations increased to 24.6% and 59.7% respectively. If the endometrium was 5-8 mm in maximum thickness by ultrasound evaluation, 54.4% of gynecologists recommended endometrial sampling.

Women receiving tamoxifen are now undergoing increased gynecologic surveillance. A rationale for annual evaluation of asymptomatic postmenopausal patients based on endometrial thickening by ultrasound examination is presented.