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Re: Tamoxifen/long term follow upFrom: Ronald Barentsen, MD (r.barentsen@azvu.nl)Wed Apr 16 10:35:20 1997
At Tue, 15 Apr 1997, Garry E. Siegel, M.D. wrote: > >I have a patient who is 6 years out from Breast Cancer, postmenopausal, >who in 1994, while on Tamoxifen, developed postmenopausal bleeding, with >a 21 mm endometrium labeled as suspicious for neoplasia by the >radiologist (she moved from out of town with that report and films). >Because my office biopsy was unsuccessful (scant tissue), she had a >hysteroscopy and D and C with more polyps than I've ever seen, like a >molar pregnancy, read as complex hyperplasia without atypia. She >subsequently was placed on Megace 20 mg. day 1 - 12, and is off >Tamoxifen as it now has been 5 years, and about 2.5 since her D and C. I >have followed her every 6 to 12 months with ultrasounds and biopsies, >which have been stable. She has not bled in some time. > >I plan to follow her with ultrasound only, and not biopsy, since I don't >think I get a good sample (I just get a little polypoid stuff with >difficulty). > >What do ya'll think? Should I stop the Megace? Continue to scan and/or >biopsy? > >Garry > >I am missing some data. Are there withdrawal bleeds after Megace? Now and in the past? If there is a hormonal stimulus to the endometrium, one should expect regular withdrawals with progestagens in adequate doses. With no withdrawal bleeds and a thin endometrium on us, stop therapy and wait. With no withdrawal bleeds and a thick endometrium perform a D&C. With regular withdrawals continue Megace until amenorrhoea >
-- Ronald Barentsen Correspondent OBGYN.net for Menopause and HRT
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