Clinical Study On The Prevention Of Endometrial Lesion Caused By Tamoxifen In Breast Cancer Patients After Operation With Mirena

Objective: To determine the effectiveness and safety of mirena in premenopausal women taking adjuvant tamoxifen following breast cancer for the outcomes of endometrial thickness and secondary breast cancer events.Methods: From 2014 to 2016,a total of 73 premenopausal women,who had diagnoised endometrial hyperplasia after adjuvant tamoxifen at least one year in department of The Forth Hospital of Hebei Medical University were enrolled in the study.They were pathologically included malignant lesions with curettage.In a prospective randomized controlled study,36 cases in the case group were treated with mirena and TAM,while 37 cases in the control group were treated with TAM without mirena.Endometrial thickness by transvaginal ultrasound were obtained at the end of the third,sixth,ninth,twelfth,twenty-fourth and thirty-sixth month.The changes of progesterone in venous blood were observed in the case group.And the outcomes of secondary breast cancer were obtainded through the regular review of galactophore department.Results:1.All the enrolled patients with endometrial thickening after clearance showed benign endometrial lesions,endometrial polyps and simple hyperplasia,with an incidence of 75.3% and 24.7% respectively.Endometrial polyp is the most common form in postmenopausal breast cancer patient with tamoxifen,and the incidence of carcinogenesis may be extremely low.2.In the control group,the proportion of patients with endometrial thickening was 35.1%,37.8%,40.5%,43.2%,66.7% and 75.8% at 3,6,9,12,24 and 36 months after clearance respectively.The difference was statistically significant(P=0.002).The incidence of endometrial heterogeneity was 37.8%,40.5%,60.0%,71.4%,78.8% and 87.9% at 3,6,9,12,24 and 36 months respectively with statistic difference(P=0.000).Endometrial thickness at 3,6,9,12,24 and 36 months after clearance was(9.22±2.08)mm,(9.08±1.94)mm,(9.62±2.55)mm,(10.35±2.56)mm,(10.45±1.89)mm,(10.67±1.80)mm respectively.The differences were statistically significant(P=0.005).3.In the case group after clearance the endometrial thickness at 3,6,9,12,24 and 36 months respectively was(9.19±1.94)mm,(7.03±1.38)mm,(6.28±1.70)mm,(6.36±1.73)mm,(6.31±1.18)mm,(6.44±1.11)mm,at 3,6,9 months,the difference was statistically significant(P=0.000),at 9,12,24,36 months,there was no statistically significant difference(P=0.258).4.The endometrial thickness before clearance was(14.55±2.48)mm in the case group and(14.27±1.99)mm in the control group showed no statistical difference(P=0.590).There was also no statistically significant difference at 3 months after clearance(P=0.963),but with the extension of time,at 6,9,12,24 and 36 months,the difference was statistically significant(P=0.000).5.Cureting pathology of endometrial thickening patients at 12 months after clearance showed that there were 4 cases(11.1%)of endometrial simple hyperplasia without endometrial polyps.In the control group,endometrial hyperplasia was found in 11 cases(30.0%)and endometrial polyps in 5 cases(13.5%).Compared with the incidence of endometrial hyperplasia and endometrial polyps in the two groups,the intrauterine implantation of mirena reduced the occurrence of endometrial lesions and prevented the recurrence of endometrial polyps with statistically significant differences(P=0.045,P=0.029).6.In the case group,venous blood progesterone level before treatment was(1.87±1.04)ng/ml,then(1.85±1.13)ng/ml,(1.99±1.41)ng/ml,(1.96±1.02)ng/ml,(2.04±0.98)ng/ml,(2.01±0.82)ng/ml,(2.01±1.04)ng/ml,after the third,sixth,ninth,twelfth,twenty-fourth and thirty-sixth month.There was no statistically significant with intra-group comparision(P=0.499).7.There were no recurrence cases with breast cancer in flow-up period.Conclusions:1.After long-term and regular use of TAM in breast cancer patients,endometrial thickness showed a gradually increasing trend with the prolongation of medication time,the proportion of patients with endometrial thickening and endometrial heterogeneity increased gradually.2.For postoperative breast cancer patients taking TAM regularly for a long time,intrauterine implantation of mirena can effectively control the thickness of endometrium and gradually thin the endometrium,which tends to be stable after 9 months of ring placement.It can reduce the occurrence of endometrial lesions,prevent the recurrence of endometrial polyps significantly,avoid repeated cleaning,and at the same time has a contraceptive effect,which is more acceptable.3.For postoperative patients with breast cancer,levonorgestrel was locally released by intrauterine implantation of mirena.With the extension of implantation time,there was no significant fluctuation of progesterone in venous blood within three years,and there was no significant difference.4.The side effects caused by long-term use of TAM can be reduced,and the risk of breast disease progression is not increased with mirena.The combination of taking TAM and mirena will be perfect in the maintenance treatment of postoperative breast cancer in female patients.