Mirena For Endometrial Protection In Women With Breast Cancer On Adjuant Tamoxifen:A Meta-Analyses

Objective:To determine the endometrial effectiveness and safety of mirena (levonorgestrel intrauterine system,LNG-IUS) in women taking adjuvant tamoxifen following breastcancer.Methods:We searched CNKI、WANFANG DATABASE、CBM、VIP、 The Cochrane Library、CBMdisc、PubMed and EMBASE to February 2016,articles language and legion unlimited. Relevant journals were also hand searched. Randomized controlled trials (RCTs) of women taking adjuvant tamoxifen following breastcancer who using LNG-IUS. Study selection and quality assessment, data extraction and analyses were undertaken by two reviewers independently according to the Cochrane Handbook for Systematic Reviews of interventions. Meta-analyses were also performed by RevMan 5.3 software.Results:Six randomised controlled trials involving 611 women were identified and are included in this review. In the included studies, the active treatment arm was the 20 μg/day levonorgestrel-releasing intrauterine system (LNG-IUS) plus tamoxifen; the control arm was tamoxifen alone.The meta-analyses showed that endometrial polys rate of TAM+LNG-IUS group was lower than TAM group (P<0.05); there were no significant differences between two groups in submucous myoma rate (P=0.17); there were no significant differences between two groups in endometrial atrophic or inactive changes rate (P=0.87); endometrial hyperplasia rate of TAM+LNG-IUS group was lower than TAM group(P<0.05); there were no significant differences between two groups in endometrial thickness (P=0.31); abnormal bleeding rate of TAM+LNG-IUS group was higer than TAM group, with a statistical significiant(P<0.05); there were no significant differences between two groups in breast cancer recurrence(P=0.32);and there were no significant differences between two groups in cancer-induced death (P=0.81)。Conclusion:LNG-IUS used in women taking adjuvant tamoxifen following breastcancer who can reduce the endometrial polys rate and endometrial Hyperplasia rate, and play a protective role in endometrium. The LNG-IUS didn’t have an increased incidence in breast cancer recurrence and cancer-induced death.