Gynecologic surveillance of women on tamoxifen.
OBJECTIVE
To determine the gynecologic surveillance practices of Connecticut physicians regarding asymptomatic, postmenopausal women receiving tamoxifen for breast cancer management prior to and following a National Cancer Institute (NCI) directive recommending ongoing study and annual pelvic examinations.


METHODS
An anonymous survey of 110 Connecticut medical oncologists, and 306 gynecologists was completed.


RESULTS
Sixty-three of 110 (57.3%) medical oncologists and 134 of 306 (43.8%) gynecologists responded to the survey. Prior to the NCI directive, 51 (81.0%) of the medical oncologists referred patients for annual gynecologic surveillance. A pelvic examination and Papanicolaou smear were anticipated. Following the NCI directive, 29 (46.0%) routinely expected an endometrial biopsy and 17 (27.0%) expected a pelvic ultrasound evaluation. Prior to the directive, 96 (71.6%) gynecologists recommended annual gynecologic surveillance and 35 (26.1%) recommended it semiannually. Following the directive, semiannual evaluation was recommended by 52 (38.8%). Prior to the directive, 11 gynecologists (8.2%) recommended annual endometrial biopsies and 21 (15.7%) pelvic ultrasound examinations. Following the directive these recommendations increased to 24.6% and 59.7% respectively. If the endometrium was 5-8 mm in maximum thickness by ultrasound evaluation, 54.4% of gynecologists recommended endometrial sampling.


CONCLUSIONS
Women receiving tamoxifen are now undergoing increased gynecologic surveillance. A rationale for annual evaluation of asymptomatic postmenopausal patients based on endometrial thickening by ultrasound examination is presented.
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven.
P E
PE
Schwartz
D001943:Breast Neoplasms / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000139:chemically induced / Q000517:prevention & control*; D010808:Physical Examination; D017698:Postmenopause; D013629:Tamoxifen / Q000009:adverse effects / Q000627:therapeutic use*; D014594:Uterine Neoplasms / Q000139:chemically induced / Q000517:prevention & control*
D013629:Tamoxifen