Sullivan
Nicolaides Pathology
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Dear all
The problem of providing an opinion on whether a patient with
breast cancer should be on tamoxifen or aromatase inhibitor occurs quite
frequently, and has been covered a couple of times in the UKNEQAS interpretive
comments scheme: see " Identifying menopause in breast cancer patients:
considerations and implications, Clemons M & Simmons C, Breast Cancer Res
Treat 104, 115-120 (2007)". I have summarised a couple of recent cases below and
my opinion. I would welcome any comments.
Thanks
A
Case 1
51 yrs old, amenorrhoea 2y, LH 11.5 IU/l, FSH
21.4 IU/l and Oestradiol <75 pmol/l. On Tamoxifen.
Opinion: Probably post-menopausal. Suggest change to arimidex
and recheck FSH
(Tamoxifen may suppress FSH by c 30-50% in some post
menopausal women - Kostoglou-Athanassiou et al, Horm Res 47, 116-120 (1997),
Lonning et al, J Steroid Biochem Mol Biol 51, 491-496 (1995))
Case 2
52yrs old, amenorrhoea <1y, LH 29.3 IU/l, FSH
37.4 IU/l and Oestradiol 254 pmol/l. On arimidex
Opinion:
Probably premenopausal. Suggest change back to tamoxifen or consider ovarian
ablation
(Arimidex may
incompletely block E2 production, FSH rise in response, sufficiently to drive E2
production back into premenopausal range)