Regular Article

British Journal of Cancer (1999) 79, 1761–1764. doi:10.1038/sj.bjc.6690280 www.bjcancer.com
Published online 12 March 1999

Ovarian cysts in women receiving tamoxifen for breast cancer

M J E Mourits1, E G E de Vries2, P H B Willemse2, K A ten Hoor1, H Hollema3, W J Sluiter4, H W A de Bruijn1 and A G J van der Zee1

  1. 1Departments of Obstetrics and Gynaecology, University Hospital Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
  2. 2Department of Medical Oncology, University Hospital Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
  3. 3Department of Pathology, University Hospital Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
  4. 4Department of Endocrinology, University Hospital Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands

Received 3 March 1998; Revised 12 September 1998; Accepted 14 October 1998.

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Abstract

Tamoxifen is a nonsteroidal anti-oestrogen with gynaecological side-effects. Only recently, ovarian cyst formation during tamoxifen treatment has been reported. The present study aimed to evaluate patient-related parameters that determine ovarian cyst formation in women using tamoxifen for breast cancer. A cross-sectional study was performed in 142 breast cancer patients using tamoxifen. Forty-five patients were also examined prior to tamoxifen treatment. Gynaecological assessment, transvaginal ultrasonography (TVU) and serum oestradiol (E2) and follicle stimulating hormone (FSH) analysis were performed. Follow-up assessments were performed twice a year. Uni- or bilateral ovarian cysts were detected by TVU in 24 tamoxifen-using patients and in one patient before tamoxifen treatment. Multiple regression analysis showed that cyst development is related (multiple R = 0.73) to high E2 (P < 0.001), younger age (P < 0.001) and absence of high-dose chemotherapy (P = 0.007). Patients with ovarian cysts had higher serum E2 levels compared to patients without cysts (1.95 vs 0.05 nmol l–1; P < 0.001). All patients after high-dose chemotherapy or older than 50 years had E2 < 0.10 nmol l–1 and/or amenorrhoea > 1 year and did not develop ovarian cysts. Patients still having a menstrual cycle during tamoxifen had a high chance (81%) of developing ovarian cysts. Breast cancer patients receiving tamoxifen only develop ovarian cysts if their ovaries are able to respond to FSH stimulation as shown by E2 production.

Keywords:

ovarian cysts, tamoxifen, breast cancer, chemotherapy, oestradiol, FSH

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