ABSTRACT
Endometrial cancer typically presents with a history of postmenopausal bleeding. The reported incidence of malignancy in women presenting with bleeding after menopause is between 5% and 15% (1-3). All women presenting in this way, therefore, warrant further investigation; the primary aim of investigation being to differentiate benign from malignant causes of bleeding. Women experiencing irregular bleeding on hormone replacement therapy also require further investigation, although the risk of malignancy is significantly lower in this group (overall relative risk 1.3%) (4). It is now well established that women treated with the anti-breast cancer drug tamoxifen are at increased risk of developing endometrial cancer (5-7). The increase in incidence of endometrial cancer in women treated with tamoxifen was twofold (0.79 vs. 0.37) in the literature review of placebo-controlled trials by Assikis et al. (8). The worldwide overview on tamoxifen as an adjuvant for breast cancer therapy from the Early Breast Cancer Trialists’ Collaborative (9) found that tamoxifen treatment in postmenopausal women
reduced mortality by almost 25% and recurrence of breast cancer by 50% (9). Because of these beneficial effects in the treatment of breast cancer, tamoxifen usage is very widespread. Special consideration is required in planning investigation and endometrial surveillance in these women.
