臨床婦人科産科77巻3号

2023年04月発行

今月の臨床 乳腺―産婦人科医が知っておくべき必須知識

乳がんの治療と管理

維持療法と産婦人科（体がん）検診

著者： 小林陽一¹ 中野紗弓¹ 松本浩範¹

所属機関： ¹杏林大学産科婦人科

ページ範囲：P.353 - P.357

文献概要

●タモキシフェン（TAM）投与中に子宮内膜がんの発症リスクは上昇するが，子宮内膜がんによる死亡率は上昇しない．

●TAMを投与されている患者には内膜増殖症や内膜がん，子宮肉腫のリスクについて十分説明する．

●TAM投与中の乳がん患者，特に閉経前の症例では定期的な婦人科検診は不要であるが，不正性器出血などの症状を認めた場合にはすみやかに婦人科を受診させる．

参考文献

1）がん情報サービス．がん種別統計情報　乳房．https://ganjoho.jp/reg_stat/statistics/stat/cancer/14_breast.html#anchor1

2）日本乳癌学会（編） : 乳癌診療ガイドライン①治療編 2022年度版．金原出版，2022

3）Swerdlow AJ, et al : Tamoxifen treatment for breast cancer and risk of endometrial cancer : a case-control study. J Natl Cancer Inst 97 : 375-384, 2005

4）Jeon J, et al : Factors associated with endometrial pathology during tamoxifen therapy in women with breast cancer : a retrospective analysis of 821 biopsies. Breast Cancer Res Treat 179 : 125-130, 2020

5）Lee M, et al : Risk factors associated with endometrial pathology in premenopausal breast cancer patients treated with tamoxifen. Yonsei Med J 61 : 317-322, 2020

6）Curtis RE, et al : Risk of malignant mixed mullerian tumors after tamoxifen therapy for breast cancer. J Natl Cancer Inst 96 : 70-74, 2004

7）Early Breast Cancer Trialists' Collaborative Group（EBCTCG） ; Davies C, et al : Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen : patient-level meta-analysis of randomised trials. Lancet 378 : 771-784, 2011

8）Fleming CA, et al : Meta-analysis of the cumulative risk of endometrial malignancy and systematic review of endometrial surveillance in extended tamoxifen therapy. Br J Surg 105 : 1098-1106, 2018

9）Committee Opinion No. 601 : Tamoxifen and uterine cancer. Obstet Gynecol 123 : 1394-1397, 2014

10）Chalas E, et al : Benign gynecologic conditions among participants in the Breast Cancer Prevention Trial. Am J Obstet Gynecol 192 : 1230-1237 ; discussion 1237-1239, 2005

11）Williams-Brown MY, et al : The effect of tamoxifen and raloxifene on estrogen metabolism and endometrial cancer risk. J Steroid Biochem Mol Biol 126 : 78-86, 2011

12）Gu R, et al : A comparison of survival outcomes and side effects of toremifene or tamoxifen therapy in premenopausal estrogen and progesterone receptor positive breast cancer patients : a retrospective cohortstudy. BMC Cancer 12 : 161, 2012

13）Hong J, et al : A prospective, randomized study of Toremifene vs. tamoxifen for the treatment of premenopausal breast cancer : safety and genital symptom analysis. BMC Cancer 20 : 663, 2020

14）Neven P, et al : Tamoxifen-induced endometrial polyp. N Engl J Med 336 : 1389 ; author reply 1389-1390, 1997

15）Chalas E, et al : Benign gynecologic conditions among participants in the Breast Cancer Prevention Trial. Am J Obstet Gynecol 192 : 1230-1237, 2005

16）日本産科婦人科学会，他（編・監修） : 産婦人科診療ガイドライン―婦人科外来編2020．日本産科婦人科学会，2020

17）Schwartz LB, et al : Use of transvaginal ultrasonography to monitor the effects of tamoxifen on uterine leiomyoma size and ovarian cyst formation. J Ultrasound Med 17 : 699-703, 1998

18）Nishiyama S, et al : Bilateral ovarian endometriomas after laparoscopic hysterectomy following adjuvant tamoxifen therapy for breast cancer : a case report. Case Rep Womens Health 36 : e00442, 2022

19）Lee S, et al : The effect of tamoxifen therapy on the endometrium and ovarian cyst formation in patients with breast cancer. Obstet Gynecol Sci 61 : 615-620, 2018

20）Seoud M, et al : Tamoxifen and ovarian cysts : a prospective study. Eur J Obstet Gynecol Reprod Bio 100 : 77-80, 2001