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Title: Endocrine agents in breast cancer : studies of tamoxifen and a new aromatase inhibitor
Author: Love, Corinne D. B.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2000
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An initial pilot study was performed to assess the incidence of abnormalities in 120 asymptomatic women on tamoxifen and to establish the most appropriate screening tool from the three assessed, transvaginal ultrasound scanning (TVUSS), out-patient hysteroscopy and pipelle biopsy. The pilot study demonstrated that all abnormalities seen at hysteroscopy were identified on TVUSS. Following this a further 237 women on tamoxifen and 130 controls had TVUSS performed and only went on to out-patient hysteroscopy if the scan was abnormal. There was a statistically significant positive correlation between length of time on tamoxifen and endometrial thickness on ultrasound scan p<0.0001) and women on tamoxifen had a significantly thicker endometrium than controls p<0.0001). 145 women (41%) had an endometrium >5mm on TVUSS and 134 of them had successful out-patient hysteroscopy. 61 women had atrophic endometrium at hysteroscopy giving a 46% false positive scan rate. The remaining women had benign features to explain the ultrasound findings including cysts in 23 women, oedematous endometrium (23), polyps (21) and submucous fibroids (6). It was concluded that ultrasound is a poor screening tool which gives a high false positive rate and the low frequency of significant findings suggests that endometrial screening in asymptomatic women is not indicated. Because of the concern regarding tamoxifen's potentially serious side effects, newer more specific antioestrogens and oral aromatase inhibitors are under investigation. Letrozole, an oral aromatase inhibitor, was investigated in 24 postmenopausal women with primary breast cancer and achieved a 92% (22/24) partial clinical response, which is at least as good as results obtained with tamoxifen. This suggests that these newer more specific endocrine agents may achieve the effects of tamoxifen without producing endometrial abnormalities. For those women on tamoxifen this study has shown that there is a low frequency of serious pathology and endometrial screening is not worthwhile.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available