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Am Fam Physician. 2006;74(7):1230

ACOG Releases Guideline on Tamoxifen for Postmenopausal Women

Tamoxifen (Nolvadex) is a nonsteroidal antiestrogen agent commonly used to treat and prevent breast cancer. However, tamoxifen may be associated with endometrial proliferation, hyperplasia, polyp formation, invasive carcinoma, and uterine sarcoma in postmenopausal women. The American College of Obstetricians and Gynecologists (ACOG) Committee on Gynecologic Practice has reviewed the risks of tamoxifen in postmenopausal women and released recommendations on its use in this population. The full guideline was published in the June 2006 issue of Obstetrics & Gynecology.

The guideline includes the following recommendations for postmenopausal women taking tamoxifen:

  • Patients should be monitored closely for endometrial hyperplasia or cancer and be informed about the risks associated with the drug.

  • Abnormal vaginal bleeding, bloody discharge, and staining or spotting should be evaluated.

  • Because some evidence suggests a higher risk in women who had benign endometrial polyps before tamoxifen therapy, pretherapy screening may have a role.

  • Routine endometrial surveillance is not recommended unless the patient is at high risk of endometrial cancer.

  • Tamoxifen should not be used for more than five years.

  • If atypical endometrial hyperplasia develops, patients should receive appropriate treatment, and the use of tamoxifen should be reassessed. Hysterectomy should be considered if tamoxifen must be continued.

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