Endometrial Cancer

Tamoxifen (Nolvadex), a nonsteroidal antiestrogen, was first approved by the FDA for the treatment of patients with breast cancer in 1978. Large clinical trials have demonstrated a recurrence-free and overall survival benefit

In his excellent review, Dr. Barakat has made many useful observations about the effects of tamoxifen (Nolvadex) on the endometrium. As the potential number of women on tamoxifen increases, several points merit emphasis and dissemination to all gynecologists who may be asked by medical oncologists to render opinions on such patients.

Tamoxifen (Nolvadex) is widely used in the treatment of breast cancer. It is effective in the management of both early stage and advanced disease. The recent comprehensive meta-analysis of systemic treatment in early breast cancer reported that tamoxifen reduced the annual odds of breast cancer recurrence by 25%, and the risk of death by 16%, compared with patients not treated with tamoxifen [1]. The benefits are even more pronounced in postmenopausal patients, with 29% decreases in recurrence and 20% reduction in the risk of death. The risk of contralateral primary breast cancer is also decreased by approximately 28% in women receiving adjuvant tamoxifen [2]. This has prompted its use in prevention trials; the National Surgical Adjuvant Breast and Bowel Project Prevention trial (NSABP P1) is an ongoing trial randomizing women at high risk for breast cancer to receive tamoxifen or placebo. Tamoxifen's use in otherwise healthy women has brought attention to the few potential toxicities of the drug.