Current issues regarding tamoxifen and the genital tract: A review

In summary, tamoxifen remains the hormonal treatment of choice for the prevention and treatment of breast cancer. The primary significant risks of tamoxifen are the increased risks of thromboembolism and uterine cancers. There is an increased risk of endometrial cancer, with a small but significant increased risk of uterine sarcomas, specifically malignant mixed mullerian tumors. Therefore, abnormal bleeding in patients on tamoxifen should be evaluated and an endometrial biopsy obtained. If no tissue is obtained by endometrial biopsy, a D& C and hysteroscopy should be considered. Other effects on the genital tract, although not life threatening, are important as they may affect the patient's quality of life. These symptoms should be addressed during the patient's gynecological evaluation, since they can be treated without adversely impacting upon the patient's breast cancer risk and treatment.