Gynecological Adverse effects of Tamoxifen Treatment to Hormone Receptor Positive Breast Cancer Female Patients

Gynecological Effects of Tamoxifen in Hormone Receptor Positive Breast Cancer Patients

Authors

  • Uzma Raza Department of Biochemistry, Hamdard College of Medicine, Hamdard University, Karachi, Pakistan
  • Aziza Khanam Department of Biochemistry, Al-Tibri Medical College and Hospital, Isra University, Karachi, Pakistan
  • Ali Iftikhar Department of Pharmacology, Karachi Institute of Medical Sciences, Karachi, Pakistan
  • Ayman Sadat Department of Microbiology, Aga Khan University and Hospital, Karachi, Pakistan
  • Sidra Rizwan Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
  • Aminuddin Sheikh Department of Pathology, Hamdard College of Medicine, Hamdard University, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i7.2968

Keywords:

Hormone receptors positive breast cancer, Tamoxifen, Adverse effects

Abstract

Tamoxifen, an oral synthetic selective estrogen modulator, has been widely used as an anti-cancer drug for over 50 years. Tamoxifen increases disease free survival and overall survival rates, when given as an adjuvant but many patients experience side effects which reduces quality of life. The present study investigates the adverse effects of tamoxifen in hormone receptor–positive breast cancer patients. Objectives: To investigate the Adverse effect of tamoxifen treatment on hormone receptor positive breast cancer patient. Methods: The longitudinal cohort study was conducted at Al-Tibri Medical College with collaboration of Liaquat National Hospital Karachi from March 2019 to Sep 2023. The study included 135 premenopausal women with hormone receptor–positive breast cancer. After surgery and chemotherapy, all received tamoxifen 20 mg/day for five years and were evaluated every six months for four years. Results: A total of 135 premenopausal hormone receptor–positive breast cancer patients were studied. Mean age was 44.6 years, and 79% had children. Endometrial thickness increased from 5.0 mm before treatment to 9.3 mm after 48 months of Tamoxifen (p<0.05). Common adverse effects included vaginal discharge (36%), hot flashes (19%), and rash pigmentation (14%). D and C and Pap smear showed mostly benign or inflammatory changes. Long-term Tamoxifen use was linked to increased endometrial thickness and mild gynecological side effects. Conclusion: Tamoxifen showed mild, tolerable side effects and histopathological changes but effectively reduced metastasis, supporting its use with regular endometrial monitoring.

References

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer Journal for Clinicians. 2021 May; 71(3): 209-249. doi: 10.3322/caac.21660. DOI: https://doi.org/10.3322/caac.21660

Burstein HJ, Lacchetti C, Anderson H, Buchholz TA, Davidson NE, Gelmon KE, et al. Adjuvant Endocrine Therapy for Women with Hormone Receptor-Positive Breast Cancer: ASCO Clinical Practice Guideline Focused Update. Journal of Clinical Oncology. 2019 Feb; 37(5): 423-38. doi: 10.1200/JCO.18.01160. DOI: https://doi.org/10.1200/JCO.18.01160

Jordan VC. Tamoxifen: A Most Unlikely Pioneering Medicine. Nature Reviews Drug Discovery. 2022 Jan; 21(1): 41-54.

Yang G, Nowsheen S, Aziz K, Georgakilas AG. Toxicity And Adverse Effects of Tamoxifen and Other Anti-Estrogen Drugs. Pharmacology & Therapeutics. 2013 Sep; 139(3): 392-404. DOI: https://doi.org/10.1016/j.pharmthera.2013.05.005

Zhang Y, Li X, Huang R, Li J, Li X, Yang L, et al. Adjuvant Treatment with Tamoxifen for Estrogen Receptor-Positive Breast Cancer and Gynecological Risks in Premenopausal and Perimenopausal Women: A Systematic Review. Systematic Reviews. 2023 May; 12(1): 78.

Rehman H, Qureshi IA, Khan S, Siddiqui T. Sonographic Changes in Ovary After Use of Tamoxifen in Breast Cancer. Professional Medical Journal. 2023 Nov; 30(11): 1372-1377. doi: 10.29309/TPMJ/2023.30.11.7674. DOI: https://doi.org/10.29309/TPMJ/2023.30.11.7674

İnal MM, İncebiyik A, Sanci M, Yildirim Y, Polat M, Pilanci B, et al. Ovarian Cysts in Tamoxifen-Treated Women with Breast Cancer. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2005 May; 120(1): 104-106. doi: 10.1016/j.ejogrb.2004.09.006. DOI: https://doi.org/10.1016/j.ejogrb.2004.09.006

Carbone A, Oliva M, Puntoni M, Guerrieri-Gonzaga A, Briata IM, Lazzeroni M, et al. Effect of Low-Dose Tamoxifen on Benign Gynecological and Breast Conditions in a Phase 3 Trial in Noninvasive Breast Cancer. Journal of the National Cancer Institute. 2025 Aug; djaf250. doi: 10.1093/jnci/djaf250. DOI: https://doi.org/10.1093/jnci/djaf250

Abd-Alhussain GK, Alatrakji MQ, Saleh WA, Fawzi HA, Mahmood AS. Effects of Tamoxifen on the Reproductive System of Female Breast Cancer Patients: An Ultrasound-Based Cohort Study. F1000Research. 2020 Feb; 9: 102. doi: 10.12688/f1000research.21481.1. DOI: https://doi.org/10.12688/f1000research.21481.1

Mofrad MH, Shandiz FH, Roodsari FV, Moghiman T. Evaluation of Ovarian Cysts in Breast Cancer Cases on Tamoxifen. Asian Pacific Journal of Cancer Prevention. 2010; 11(1): 161-164.

Gradishar WJ, Moran MS, Abraham J, Aft R, Agnese D, Allison KH, et al. Breast Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network. 2022 Jun; 20(6): 691-722. DOI: https://doi.org/10.6004/jnccn.2022.0030

Lee WL, Cheng MH, Chao HT, Wang PH. The Role of Selective Estrogen Receptor Modulators on Breast Cancer: From Tamoxifen to Raloxifene. Taiwan Journal of Obstetrics and Gynecology. 2008 Mar; 47(1): 24-31. doi: 10.1016/S1028-4559(08)60051-0. DOI: https://doi.org/10.1016/S1028-4559(08)60051-0

Hu R, Hilakivi-Clarke L, Clarke R. Molecular Mechanisms of Tamoxifen-Associated Endometrial Cancer (Review). Oncology Letters. 2015 May; 9(5): 1495-1501. doi: 10.3892/ol.2015.2962. DOI: https://doi.org/10.3892/ol.2015.2962

Jeon SJ, Lee JI, Lee M, Park JH, Lee YY, Kim TJ, et al. Endometrial Polyp Surveillance in Premenopausal Breast Cancer Patients Using Tamoxifen. Obstetrics and Gynecology Science. 2017 Jan; 60(1): 26-31. doi: 10.5468/ogs.2017.60.1.26. DOI: https://doi.org/10.5468/ogs.2017.60.1.26

Ghanavati M, Khorshidi Y, Shadnoush M, Poopak A, Faghih D, Tamehri Zadeh SS, et al. Tamoxifen Use and Risk of Endometrial Cancer in Breast Cancer Patients: A Systematic Review and Dose-Response Meta-Analysis. Cancer Reports (Hoboken). 2023 Apr; 6(4): e1806. doi: 10.1002/cnr2.1806. DOI: https://doi.org/10.1002/cnr2.1806

Lee M, Piao J, Jeon MJ. Risk Factors Associated with Endometrial Pathology in Premenopausal Breast Cancer Patients Treated with Tamoxifen. Yonsei Medical Journal. 2020 Apr; 61(4): 317-322. doi: 10.3349/ymj.2020.61.4.317. DOI: https://doi.org/10.3349/ymj.2020.61.4.317

Choi S, Lee YJ, Jeong JH, Jung J, Lee JW, Kim HJ, et al. Risk of Endometrial Cancer and Frequencies of Invasive Endometrial Procedures in Young Breast Cancer Survivors Treated with Tamoxifen: A Nationwide Study. Frontiers in Oncology. 2021 Apr; 11: 636378. doi: 10.3389/fonc.2021.636378. DOI: https://doi.org/10.3389/fonc.2021.636378

Jeon SJ, Kim SE, Lee DY, Lee JE, Cho EY, Choi YL, et al. Factors Associated with Endometrial Pathology During Tamoxifen Therapy in Women with Breast Cancer: A Retrospective Analysis of 821 Biopsies. Breast Cancer Research and Treatment. 2020 Jan; 179(1): 125-130. doi: 10.1007/s10549-019-05448-w. DOI: https://doi.org/10.1007/s10549-019-05448-w

Ryu KJ, Kim MS, Lee JY, Seong SJ, Jeong HG, Kim T, et al. Risk of Endometrial Polyps, Hyperplasia, Carcinoma, and Uterine Cancer After Tamoxifen Treatment in Premenopausal Women with Breast Cancer. Journal of the American Medical Association Network Open. 2022 Nov; 5(11): e2243951. doi: 10.1001/jamanetworkopen.2022.43951. DOI: https://doi.org/10.1001/jamanetworkopen.2022.43951

Lee Y, Park YR, Kim HR, Lee JW. Event-Free Survival Following Early Endometrial Events in Breast Cancer Patients Treated with Anti-Hormonal Therapy: A Nested Case-Control Study. Medicine (Baltimore). 2019 Jan; 98(2): e13976. doi: 10.1097/MD.0000000000013976. DOI: https://doi.org/10.1097/MD.0000000000013976

Vizzotto A Jr, Nicolau SM, Lopes GM, Castelo Filho A. Risk Factors for the Development of Endometrial Lesions in Breast Cancer Patients Using Tamoxifen: A Retrospective Cohort Study. Revista do Colegio Brasileiro de Cirurgioes. 2023 Mar; 50: e20233442. doi: 10.1590/0100-6991e-20233442-en. DOI: https://doi.org/10.1590/0100-6991e-20233442

Cetin F, Kayar I, Goe G, Birge O. The Impact of Tamoxifen Usage in Breast Cancer Patients on the Development of Histopathological Lesion in Cervix Uteri. Medicina (Kaunas). 2024 Aug; 60(8): 1268. doi: 10.3390/medicina60081268. DOI: https://doi.org/10.3390/medicina60081268

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Published

2025-07-31
CITATION
DOI: 10.54393/pjhs.v6i7.2968
Published: 2025-07-31

How to Cite

Raza, U., Khanam, A., Iftikhar, A., Sadat, A., Rizwan, S., & Sheikh, A. (2025). Gynecological Adverse effects of Tamoxifen Treatment to Hormone Receptor Positive Breast Cancer Female Patients: Gynecological Effects of Tamoxifen in Hormone Receptor Positive Breast Cancer Patients. Pakistan Journal of Health Sciences, 6(7), 310–314. https://doi.org/10.54393/pjhs.v6i7.2968

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