title: Endometrial polyps in obese asymptomatic pre and postmenopausal patients with breast cancer: is screening necessary?
abstract: OBJECTIVE
  To evaluate the prevalence of endometrial polyps in obese asymptomatic pre and postmenopausal patients with breast cancer and to know if a baseline pretamoxifen endometrial assessment should be taken into consideration in these women at high risk.
  
  
  METHODS
  A cross-sectional study was carried out with 201 women with breast cancer. A diagnostic hysteroscopy was performed in all women. All formations suspected as polyps were removed. The prevalence of endometrial polyps was analyzed in all patients (n=182) and in premenopausal (n=49) and postmenopausal (n=118) women with estrogen receptor (ER) positive breast cancer (BC) according to their body mass index (BMI) and other risk factors.
  
  
  RESULTS
  Hysteroscopic evaluation was possible in 182 cases (90.5%). Of the total of women, 160 (87.9%) were ER(+)BC patients, 133 (73.1%) postmenopausal women and 41.5% were obese (BMI≥30kg/m(2)). Endometrial polyps were found in 52 cases (28.5%) (3 cases of simple hyperplasia harbored within a polyp). In premenopausal patients with ER(+)BC, there were no statistical differences in endometrial polyps according to their BMI (22.3% in non-obese women vs 31.7% in obese) while in all patients (26.4% in non-obese vs 44.0% in obese) and in postmenopausal women with ER(+)BC (25.9% in non-obese vs 48.6% in obese) there were statistical differences. In all women the relative risk (RR) of endometrial polyps in obese patients was 2.24 (1.01-4.83), in obese postmenopausal women with ER(+)BC was 2.75 (1.01-7.40) and in obese premenopausal patients with ER(+)BC was 1.42 (0.80-3.29).
  
  
  CONCLUSIONS
  Asymptomatic women with breast cancer have a high prevalence of baseline subclinical endometrial polyps and it is very high in obese postmenopausal patients with estrogen receptor positive breast cancer. Therefore, there may be a future role for baseline pretamoxifen screening of some sort for the obese asymptomatic postmenopausal patient, especially if they are elderly and ER positive.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Puerto Real, Faculty of Medicine, University of Cádiz, Spain. Electronic address: dmlulo@gmail.com.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Lubián López
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Puerto Real, Faculty of Medicine, University of Cádiz, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Orihuela López
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Puerto Real, Faculty of Medicine, University of Cádiz, Spain.
authors.forename: Lucía
authors.initials: L
authors.lastname: García-Berbel Molina
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Puerto Real, Faculty of Medicine, University of Cádiz, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Boza Novo
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Puerto Real, Faculty of Medicine, University of Cádiz, Spain.
authors.forename: Estrella
authors.initials: E
authors.lastname: Pozuelo Solís
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Puerto Real, Faculty of Medicine, University of Cádiz, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Menor Almagro
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Puerto Real, Faculty of Medicine, University of Cádiz, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Comino Delgado
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000150:complications* / Q000378:metabolism; D003430:Cross-Sectional Studies; D016889:Endometrial Neoplasms / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis*; D009765:Obesity / Q000150:complications*; D011127:Polyps / Q000150:complications / Q000175:diagnosis*; D017698:Postmenopause; D017697:Premenopause; D011960:Receptors, Estrogen / Q000378:metabolism
chemical_list: D011960:Receptors, Estrogen
keywords: Body mass index; Breast cancer; Endometrial polyp; Hysteroscopy; Menopausal status; Obesity