12-05-2011, 08:53 PM
A 55-year-old Caucasian woman comes to see you in the office for a follow-up visit. She has a history of breast cancer in the left breast two years ago, for which she underwent a mastectomy. Her breast cancer was found to be estrogen receptor positive, and she was started on tamoxifen for adjuvant hormone therapy at that time. The patient has recently learned on television that tamoxifen can cause an increase in the incidence of uterine cancer. She wants you to "check her completely" for any evidence of uterine cancer. Which of the following is the most appropriate surveillance strategy for uterine cancer in patients on tamoxifen?
A) Careful history and annual Pap smears
B) Semiannual transvaginal ultrasound for endometrial thickening
C) Annual CT scan of the pelvis for endometrial hyperplasia
D) Annual endometrial biopsy