The Effect Of Mirena Intervention On The Tamoxifen-induced Endometrial Lesion In Postoperative Patients With Breast Cancer

Objective:To explore the clinical outcome of Mirena for intervening tamoxifen-induced endometrial lesions in postoperative patients with breast cancer,through a case-control study for breast cancer patients with oral tamoxifen.Methods : From November 2014 to May 2015, a total of 73 premenopausal women, who had diagnozd endometrial thickening by hysteroscope and transvaginal ultrasound after adjuvent treatment at least 1 year and were undergoing regular follow-up for breast cancer in department of The Fourth Hospital of Hebei Medical University, were enrolled in the study. They were pathologicall encluded malignant lesions with hysteroscope and complete curettage of uterine cavity, and then were randomlly divided into mirena group(36 cases) who were treated with mirena after complete curettage of uterine cavity and control group(37 cases). All women continued to be treated with TAM and were followed for 12 months. Endometrial thickness by transvaginal ultrasonography, vaginal bleeding and breast cancer progress were obtained at the end of the third, sixth, ninth, and twelfth month. The type and incidence of endometrial lesions were analyzed at the begining and the end of the twelfth month in both groups. Meanwhile, serum progesterone were measured at the begining and the end of the twelfth month in mirena group.Results:1 In 73 cases breast cancer patients treated with complete curettage of uterine cavity, pothologic outcome showed that there were 55 cases(75.3%) endometrial hyperplasia(simple hyperplasia, complex hyperplasia and chronic inflammatory hyperplasia), 18cases(24.7%) endometrial polyp, none atypical endometrial hyperplasia and endometial carcinoma.2 With transvaginal ultrasound observation, the endometrial average thickness was(14.55±2.48)mm,(9.00±1.92)mm,(7.03±1.23)mm,(6.33±1.93) mm,(6.36±1.76)mm, respectively at the begining, third, sixth, ninth and twelfth month in mirena group.The endometrial average thickness was(14.27±1.99)mm,(9.19±2.11)mm,(9.22±2.15)mm,(9.38±2.94)mm,(10.65±3.02)mm, respectively at the begining, third, sixth, ninth and twelfth month in control group. From the sixth, ninth and twelfth month, the difference of endometrial thickness in the two groups was statiatically difference(P=0.012, P=0.000, P=0.000).3 After 12 months of follow-up, the patients of two groups, whose endometrial thickness more than 10mm(4cases account 11.1% in the mirena group and 16 cases account 43.2% in the control groups) by vaginal ultrasonography, received diagnosed curettage of uterine cavity. The incidence of endometrial thickening between the two groups was statistically significent(P=0.002). The pathological results showed that 4 cases(11.1%) in the mirena group were endometrial benign hyperplasis(the same with before treatment), 5 cases(13.5%) in the control group were endometrial polyps(recurrence of 3 cases and new incidence of 2 cases) and the rest of 11 cases(30.0%) in the control group were endometrial benign hyperplasia(all for recurrence).The incidence of endometrial benignt hyperplasia and endometrial polyps between groups was statistically different(P=0.045, P=0.029).4 In mirena group,venous blood progesterone level before treatment was(1.87±1.04)ng/ml,then,(1.85±1.1)ng/ml,(1.99±1.41)ng/ml,(1.96±1.02)ng/ml,(2.04±0.98)ng/ml, after the third, sixth, ninth, twelfth month. There was no statistically differerce intra-group comparision(P=0.828,P=0.679,P=0.737,P= 0.500).5 In follow-up period, 24 cases(66.7%) irregular vaginal bleeding occured in mirena group, but only 2(5.4%) cases in control group. There was statistically differerce(P=0.000). But, 15cases(62.9%) and 7 cases(29.1%) vaginal bleeding were disappeared,respectively at the third and sixth month.6 There were no recurrence cases with breast cancr in follow-up period.Conclusion:1 Mirena can effectively intervene the tamoxifen-induced endometrial thickening in postoperative patients with breast cancer, especially endometrial polyps, and is more persistent, effective, and ecomomic than simple curettage.2 Mirena locally roles in uterine cavity, and could not influence the level of progesterone in venous blood and cause recurrence of breast cancer patients.3 Mirena can cause side effects such as irregular vaginal bleeding.4 Mirena could hopefully become an effective measure for tamoxifen-indu ced endometrial lesions in postoperative patients with breast cancer.