Screening asymptomatischer Frauen auf Endometriumkarzinom mit besonderer Berücksichtigung des Screenings unter Tamoxifen-Behandlung

 

 Buy Article Permissions and Reprints

Zusammenfassung

Beim Endometriumkarzinom tritt als Frühsymptom in den meisten Fällen eine Postmenopausenblutung auf. 75 % der Patientinnen weist zu diesem Zeitpunkt ein Stadium I auf. Die 5-Jahres-Überlebensrate liegt beim Endometriumkarzinom um 75 %. Ein generelles Screening von Frauen ohne Blutungsanomalien, abnormen Fluor und ohne andere Symptomatik erscheint nicht indiziert. Dies gilt in gleicher Weise auch für Patientinnen unter Tamoxifentherapie wegen eines Mammakarzinoms.

Abstract

Most patients with endometrial carcinoma present with postmenopausal vaginal bleeding and 75 % will have stage I disease. The overall 5-year survival rate of patients with endometrial carcinoma is about 75 %. Routine screening of women without postmenopausal bleeding, abnormal vaginal discharge or other symptoms does not seem justified. The same applies to patients receiving tamoxifen.

Literatur

• 1 Archer D, McIntre-Seltman K, Wilborn W, Dowling E, Cone F, Creasy G, Kafrissen M. Endometrial morphology in asymptomatic postmenopausal women.  Amer J Obstet Gynecol. 1991;  165 317-322
  PubMedGoogle Scholar
• 2 Barakat R. Screening for endometrial cancer in a patient receiving tamoxifen for breast cancer.  J Clin Oncol. 1999;  17 1967-1968
  PubMedGoogle Scholar
• 3 Barakat R, Gilewski T, Almadrones L, Saigo P, Venkatraman E, Hoskins W. The effect of adjuvant tamoxifen on the endometrium in women with breast cancer: A prospective study.  Proc ASCO. 1999;  18
  PubMedGoogle Scholar
• 4 Berliere M, Charles A, Galant C, Donnez J. Uterine side effects of tamoxifen: A need for systematic pretreatment screening.  Obstet Gynecol. 1998;  91 40-44
  CrossrefPubMedGoogle Scholar
• 5 Bertelli G, Venturini M, Del Mastro L, Garrone O, Cosso M, Gustavino C, Cusimano E, Guido T, Nicolo G, Rosso R. Tamoxifen and the endometrium: findings of pelvic ultrasound examination and endometrial biopsy in asymptomatic breast cancer patients.  Breast Cancer Res Treat. 1998;  47 41-46
  CrossrefPubMedGoogle Scholar
• 6 Brooks S, Yeatts-Peterson M, Baker S, Reuter K. Thickened endometrial stripe and/or endometrial fluid as a marker of pathology: Fact or fancy?.  Gynecol Oncol. 1996;  63 19-24
  CrossrefPubMedGoogle Scholar
• 7 Burk J, Lehman H, Wolf F. Inadequacy of Papanicolao smears in the detection of endometrial cancer.  New Engl J Med. 1974;  270 191-192
  PubMedGoogle Scholar
• 8 Cecchini S, Ciatto S, Bonardi R, Mazzotta A, Grazzini G, Pacini P, Muraca M. Screening by ultrasonography for endometrial carcinoma in postmenopausal breast cancer patients under adjuvant tamoxifen.  Gynecol Oncol. 1996;  60 409-411
  CrossrefPubMedGoogle Scholar
• 9 Cohen I, Rosen D, Shapira J, Cordoba M, Gilboa S, Altaras M, Yigael D, Beyth Y. Endometrial changes with tamoxifen: Comparison between tamoxifen-treated and nontreated asymptomatic postmenopausal breast cancer patients.  Gynecol Oncol. 1994;  52 185-190
  CrossrefPubMedGoogle Scholar
• 10 Cohen I, Tepper R, Rosen D, Shapira J, Cordoba M, Dror Y, Altaras M, Beyth Y. Continous tamoxifen treatment in asymptomatic postmenopausal breast cancer patients does not cause aggravation of endometrial pathologies.  Gynecol Oncol. 1994;  55 138-143
  CrossrefPubMedGoogle Scholar
• 11 Early Breast Cancer Trialist's Collaborative Group . Tamoxifen for early breast cancer: an overview of the randomised trials.  Lancet. 1998;  351 1451-1467
  CrossrefPubMedGoogle Scholar
• 12 Eddy G, Wojtowycz M, Piraino P, Mazur M. Papanicolao smears by the Bethesda system in endometrial malignancy: Utility and prognostic importance.  Obstet Gynecol. 1997;  90 999-1003
  CrossrefPubMedGoogle Scholar
• 13 Franchi M, Ghezzi F, Donadello N, Zanaboni F, Beretta P, Bolis P. Endometrial thickness in tamoxifen-treated patients: An independent predictor of endometrial disease.  Obstet Gynecol. 1999;  93 1004-1008
  CrossrefPubMedGoogle Scholar
• 14 Fukuda K, Mori M, Uchiyama M, Iwai K, Iwasaka T, Sugimori H, Yamasaki F. Preoperative cervical cytology in endometrial carcinoma and its clinicopathologic relevance.  Gynecol Oncol. 1999;  72 273-277
  CrossrefPubMedGoogle Scholar
• 15 Grönross M, Salmi T, Vuento M, Jalava A, Tyrkkö J, Maatela J, Aromaa A, Siegberg R, Savolainen E. Mass screening for endometrial cancer directed in risk groups of patients with diabetes and patients with hypertension.  Cancer. 1993;  71 1279-1282
  PubMedGoogle Scholar
• 16 Gull B, Karlsson B, Milsom I, Wikland M, Granberg S. Transvaginal sonography of the endometrium in a representative sample of postmenopausal women.  Ultras Obstet Gynecol. 1996;  7 322-327
  PubMedGoogle Scholar
• 17 Kedar R, Bourne T, Collins W, Ashley S, Cosgrove D, Campbell S. Effects of tamoxifen on uterus and ovaries of postmenopausal women in a randomised breast cancer prevention trial.  Lancet. 1994;  343 1318-1321
  CrossrefPubMedGoogle Scholar
• 18 Koss L, Schreiber K, Oberlander S, Moukhtar M, Leveine H, Moussouris H. Screening of asymptomatic women for endometrial cancer.  Obstet Gynecol. 1981;  57 681-691
  PubMedGoogle Scholar
• 19 Langer R, Pierce J, O'Hanlan K, Johnson S, Espeland M, Trabal J, Barnabei V, Merino M, Scully R. Transvaginal ultrasonography compared with endometrial biopsy for the detection of endometrial disease.  New Engl J Med. 1997;  337 1792-1798
  CrossrefPubMedGoogle Scholar
• 20 Lindgren R, Mattson L, Andersson K, Lagrelius A, Sandin K, Karlsson K, Risberg B. Transvaginal ultrasonography and endometrial histology in peri- and postmenopausal women on hormone replacement therapy.  Brit J Obstet Gynaecol. 1999;  106 421-426
  PubMedGoogle Scholar
• 21 Love C, Muir B, Scrimgeour J, Leonard R, Dillon P, Dixon J. Investigation of endometrial abnormalities in asymptomatic women treated with tamoxifen and an evaluation of the role of endometrial screening.  J Clin Oncol. 1999;  17 2050-2054
  PubMedGoogle Scholar
• 22 McGonigle K, Marx H, Morgan R, Maryon T, Chen E, Roy S, Vasilev S, Wong P, Roach L, Wilczynski P, Simpson J. Uterine effects of tamoxifen: A prospective study.  Gynecol Oncol. 1994;  74 324-325
  PubMedGoogle Scholar
• 23 Mourits M, Van der Zee A, Willemse H, Hoor T, Hollema H, De Vries E. Discrepancy between ultrasonography and hysteroscopy and histology of endometrium in postmenopausal breast cancer patients using tamoxifen.  Gynecol Oncol. 1999;  73 21-26
  CrossrefPubMedGoogle Scholar
• 24 Obwegeser R, Chalubinsky K, Turnheim K, Auerbach L. Klinische Relevanz sonomorphologischer Veränderungen des Endometriums unter Tamoxifentherapie.  Geburtsh Frauenheilk. 1997;  57 371-375
  PubMedGoogle Scholar
• 25 Osmers R, Völksen M, Schauer A. Vaginosonography for early detection of endometrial carcinoma?.  Lancet. 1990;  335 1569-1571
  CrossrefPubMedGoogle Scholar
• 26 Runowicz C, Costantino J, Kavanagh M, Geyer C, Daly M, Lewis G, Levy L, Wickerham D, Wieand H. National surgical adjuvant breast and bowel project (NSABP) breast cancer prevention trial summary analysis of transvaginal sonography and endometrial biopsy in detecting endometrial pathology.  Proc ASCO. 1999;  18
  PubMedGoogle Scholar
• 27 Schmidt T, Rein D, Römer T, Straube W, Mallmann P. Hysteroskopische Befunde bei asymptomatischen postmenopausalen Patientinnen mit sonographisch suspektem Endometrium - Ein Vergleich mit sonographischen und histologischen Befunden.  Geburtsh Frauenheilk. 1999;  59 163-166
  Article in Thieme ConnectPubMedGoogle Scholar
• 28 Seoud M, Shamseddine A, Khalil A, Salem Z, Saghir N, Bikhazi K, Bitar N, Azar G, Kaspar H. Tamoxifen and endometrial pathologies: A prospective study.  Gynecol Oncol. 1999;  75 15-19
  CrossrefPubMedGoogle Scholar
• 29 Tepper R, Beyth Y, Altaras M, Zalel Y, Shapira J, Cordoba M, Cohen I. Value of sonohysterography in asymptomatic postmenopausal tamoxifen-treated patients.  Gynecol Oncol. 1997;  64 386-391
  CrossrefPubMedGoogle Scholar
• 30 Timmermann D, Deprest J, Bourne T, Van der Berghe I, Collins W, Vergote I. A randomized trial on the use of ultrasonography or office hysteroscopy for endometrial assessment in postmenopausal patients with breast cancer who were treated with tamoxifen.  Amer J Obstet Gynecol. 1998;  179 62-70
  PubMedGoogle Scholar
• 31 Tsuda H, Kawabata M, Yamamoto K, Inoue T, Umesaki N. Prospective study to cmpare endometrial cytology and transvaginal ultrasonography for identification of endometrial malignancies.  Gynecol Oncol. 1997;  65 383-386
  CrossrefPubMedGoogle Scholar
• 32 Turaine P, Driguez P, Cartier I, Yaneva H, Kuttenn F, Mauvais-Jarvis P. Lack of induction of endometrial hyperplasia with tamoxifen.  Lancet. 1995;  345 254-255
  CrossrefPubMedGoogle Scholar
• 33 Vuento M, Maatela J, Tyrkkö J, Laippala P, Grönroos M, Salmi T. A longitudinal study of screening for endometrial cancer by endometrial biopsy in diabetic females.  Int J Gynecol Cancer. 1995;  5 390-395
  CrossrefPubMedGoogle Scholar
• 34 Vuento M, Stenman U, Pirhonen J, Mäkinen J, Laippala P, Salmi T. Significance of a single CA 125 assay combined with ultrasound in the early detection of ovarian and endometrial cancer.  Gynecol Oncol. 1997;  64 141-146
  CrossrefPubMedGoogle Scholar
• 35 Vuento M, Pirhonen J, Mäkinen J, Tyrkkö J, Laippala P, Grönroos M, Salmi T. Screening for endometrial cancer in asymptomatic postmenopausal women with conventional and colour Doppler sonography.  Brit J Obstet Gynaecol. 1999;  106 14-20
  PubMedGoogle Scholar

Prof. Dr. Edgar Petru

Geburtshilflich-gynäkologische Universitätsklinik

Auenbruggerplatz 14

8036 Graz

Österreich