With a growing number of women taking tamoxifen citrate for treatment and prevention of breast cancer, the elevated risk of uterine cancer is an issue that the women's health community must keep an eye on. Radiology professionals are doing their part that by taking a closer look at the role of uterine imaging in this patient population.
In a paper published in Radiology, radiologists from America and Japan teamed up to devise an imaging algorithm for women who are taking the anti-estrogen agent. The American College of Obstetricians and Gynecologists recommends that practitioners be aware of the increased possibility of endometrial malignancy, and that screening procedures should be considered.
Dr. Susan Ascher is a co-author of "Tamoxifen-induced Uterine Abnormalities: The Role of Imaging," (Radiology, January 2000, Vol. 214:1, pp. 29-38) and the director of abdominal imaging at the Georgetown University Medical Center in Washington D.C.
"With this imaging algorithm, we tried to come up with something that could be the beginning of a discussion," Ascher said.
The algorithm for uterine imaging is based on previous evaluations of several modalities. Ascher recommends starting with endovaginal ultrasound to assess endometrial thickness. If abnormalities are found, follow-up modalities are hysterosonography, to image polyps and cysts, or MRI, which can demonstrate endometrial and myometrial pathologic conditions, the paper states.
One of the main questions that medical professionals are still grappling with is when a tamoxifen-treated patient should undergo screening. ACOG's guidelines state that screening should be done on women who experience vaginal bleeding, but Ascher questioned whether it would also benefit women who are asymptomatic.
"If more women are given tamoxifen, the number of women are possibly at a higher risk for uterine cancer should be greater," she said. "One plus is that, if a woman bleeds, it is early in the (treatment) process. But shouldn't asymptomatic women have access to a thorough evaluation?"
As patients become more savvy about their healthcare needs, doctors are going to have to address their concerns about preventive screening, Ascher said. In terms of equipment, the majority of imaging facilities should be able to accommodate patients, but cost could be an issue. As yet no studies have been done to determine if one modality is more cost-effective than another for uterine imaging.
Tamoxifen has been prescribed to women in the advanced stages of breast cancer for more than two decades. In October 1998, the U.S. Food and Drug Administration approved the drug for reducing incidence of breast cancer in women who are at a high risk for developing the disease. A 1993 National Cancer Institute study demonstrated that tamoxifen reduced the chance of getting breast cancer by 44%. According to a study at Oxford University in the United Kingdom, tamoxifen could save another 20,000 lives a year if it were distributed more widely to younger breast cancer patients.
To view the full text of this journal article, visit
http://radiology.rsnajnls.org/cgi/content/full/214/1/29
In a paper published in Radiology, radiologists from America and Japan teamed up to devise an imaging algorithm for women who are taking the anti-estrogen agent. The American College of Obstetricians and Gynecologists recommends that practitioners be aware of the increased possibility of endometrial malignancy, and that screening procedures should be considered.
Dr. Susan Ascher is a co-author of "Tamoxifen-induced Uterine Abnormalities: The Role of Imaging," (Radiology, January 2000, Vol. 214:1, pp. 29-38) and the director of abdominal imaging at the Georgetown University Medical Center in Washington D.C.
"With this imaging algorithm, we tried to come up with something that could be the beginning of a discussion," Ascher said.
The algorithm for uterine imaging is based on previous evaluations of several modalities. Ascher recommends starting with endovaginal ultrasound to assess endometrial thickness. If abnormalities are found, follow-up modalities are hysterosonography, to image polyps and cysts, or MRI, which can demonstrate endometrial and myometrial pathologic conditions, the paper states.
One of the main questions that medical professionals are still grappling with is when a tamoxifen-treated patient should undergo screening. ACOG's guidelines state that screening should be done on women who experience vaginal bleeding, but Ascher questioned whether it would also benefit women who are asymptomatic.
"If more women are given tamoxifen, the number of women are possibly at a higher risk for uterine cancer should be greater," she said. "One plus is that, if a woman bleeds, it is early in the (treatment) process. But shouldn't asymptomatic women have access to a thorough evaluation?"
As patients become more savvy about their healthcare needs, doctors are going to have to address their concerns about preventive screening, Ascher said. In terms of equipment, the majority of imaging facilities should be able to accommodate patients, but cost could be an issue. As yet no studies have been done to determine if one modality is more cost-effective than another for uterine imaging.
Tamoxifen has been prescribed to women in the advanced stages of breast cancer for more than two decades. In October 1998, the U.S. Food and Drug Administration approved the drug for reducing incidence of breast cancer in women who are at a high risk for developing the disease. A 1993 National Cancer Institute study demonstrated that tamoxifen reduced the chance of getting breast cancer by 44%. According to a study at Oxford University in the United Kingdom, tamoxifen could save another 20,000 lives a year if it were distributed more widely to younger breast cancer patients.
To view the full text of this journal article, visit
http://radiology.rsnajnls.org/cgi/content/full/214/1/29
