Skip to main content
PMC home page
British Journal of Cancer logoLink to British Journal of Cancer
. 1999 Apr;79(11-12):1761–1764. doi: 10.1038/sj.bjc.6690280

Ovarian cysts in women receiving tamoxifen for breast cancer

M J E Mourits 1, E G E de Vries 2, P H B Willemse 2, K A ten Hoor 1, H Hollema 3, W J Sluiter 4, H W A de Bruijn 1
PMCID: PMC2362821  PMID: 10206289

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. © 1999 Cancer Research Campaign

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

Full Text

The Full Text of this article is available as a PDF (72.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andersson M., Storm H. H., Mouridsen H. T. Incidence of new primary cancers after adjuvant tamoxifen therapy and radiotherapy for early breast cancer. J Natl Cancer Inst. 1991 Jul 17;83(14):1013–1017. doi: 10.1093/jnci/83.14.1013. [DOI] [PubMed] [Google Scholar]
  2. Barbieri R. L., Ferracci A. L., Droesch J. N., Rochelson B. L. Ovarian torsion in a premenopausal woman treated with tamoxifen for breast cancer. Fertil Steril. 1993 Feb;59(2):459–460. doi: 10.1016/s0015-0282(16)55688-x. [DOI] [PubMed] [Google Scholar]
  3. Bines J., Oleske D. M., Cobleigh M. A. Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer. J Clin Oncol. 1996 May;14(5):1718–1729. doi: 10.1200/JCO.1996.14.5.1718. [DOI] [PubMed] [Google Scholar]
  4. Boccardo F., Rubagotti A., Amoroso D., Sismondi P., Genta F., Nenci I., Piffanelli A., Farris A., Castagnetta L., Traina A. Chemotherapy versus tamoxifen versus chemotherapy plus tamoxifen in node-positive, oestrogen-receptor positive breast cancer patients. An update at 7 years of the 1st GROCTA (Breast Cancer Adjuvant Chemo-Hormone Therapy Cooperative Group) trial. Eur J Cancer. 1992;28(2-3):673–680. doi: 10.1016/s0959-8049(05)80123-6. [DOI] [PubMed] [Google Scholar]
  5. Cohen I., Beyth Y., Tepper R., Shapira J., Zalel Y., Figer A., Cordoba M., Yigael D., Altaras M. M. Ovarian tumors in postmenopausal breast cancer patients treated with tamoxifen. Gynecol Oncol. 1996 Jan;60(1):54–58. doi: 10.1006/gyno.1996.0011. [DOI] [PubMed] [Google Scholar]
  6. Cohen I., Rosen D. J., Altaras M., Beyth Y., Shapira J., Yigael D. Tamoxifen treatment in premenopausal breast cancer patients may be associated with ovarian overstimulation, cystic formations and fibroid overgrowth. Br J Cancer. 1994 Mar;69(3):620–621. doi: 10.1038/bjc.1994.116. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fisher B., Redmond C. New perspective on cancer of the contralateral breast: a marker for assessing tamoxifen as a preventive agent. J Natl Cancer Inst. 1991 Sep 18;83(18):1278–1280. doi: 10.1093/jnci/83.18.1278. [DOI] [PubMed] [Google Scholar]
  8. Fornander T., Rutqvist L. E., Cedermark B., Glas U., Mattsson A., Silfverswärd C., Skoog L., Somell A., Theve T., Wilking N. Adjuvant tamoxifen in early breast cancer: occurrence of new primary cancers. Lancet. 1989 Jan 21;1(8630):117–120. doi: 10.1016/s0140-6736(89)91141-0. [DOI] [PubMed] [Google Scholar]
  9. Gerhard I., Runnebaum B. Comparison between tamoxifen and clomiphene therapy in women with anovulation. Arch Gynecol. 1979;227(4):279–288. doi: 10.1007/BF02109916. [DOI] [PubMed] [Google Scholar]
  10. Granberg S., Wikland M., Jansson I. Macroscopic characterization of ovarian tumors and the relation to the histological diagnosis: criteria to be used for ultrasound evaluation. Gynecol Oncol. 1989 Nov;35(2):139–144. doi: 10.1016/0090-8258(89)90031-0. [DOI] [PubMed] [Google Scholar]
  11. Jolles C. J., Smotkin D., Ford K. L., Jones K. P. Cystic ovarian necrosis complicating tamoxifen therapy for breast cancer in a premenopausal woman. A case report. J Reprod Med. 1990 Mar;35(3):299–300. [PubMed] [Google Scholar]
  12. Narod S. A., Risch H., Moslehi R., Dørum A., Neuhausen S., Olsson H., Provencher D., Radice P., Evans G., Bishop S. Oral contraceptives and the risk of hereditary ovarian cancer. Hereditary Ovarian Cancer Clinical Study Group. N Engl J Med. 1998 Aug 13;339(7):424–428. doi: 10.1056/NEJM199808133390702. [DOI] [PubMed] [Google Scholar]
  13. Powles T. J., Jones A. L., Ashley S. E., O'Brien M. E., Tidy V. A., Treleavan J., Cosgrove D., Nash A. G., Sacks N., Baum M. The Royal Marsden Hospital pilot tamoxifen chemoprevention trial. Breast Cancer Res Treat. 1994;31(1):73–82. doi: 10.1007/BF00689678. [DOI] [PubMed] [Google Scholar]
  14. Re A., Wierdis T., Tessarolo M., Leo L., Bellino R., Lauricella A., Lanza A. Two cases of ovarian cysts in postmenopausal patients under antiestrogen treatment. Clin Exp Obstet Gynecol. 1994;21(4):221–224. [PubMed] [Google Scholar]
  15. Rossing M. A., Daling J. R., Weiss N. S., Moore D. E., Self S. G. Ovarian tumors in a cohort of infertile women. N Engl J Med. 1994 Sep 22;331(12):771–776. doi: 10.1056/NEJM199409223311204. [DOI] [PubMed] [Google Scholar]
  16. Santen R. J., Manni A., Harvey H., Redmond C. Endocrine treatment of breast cancer in women. Endocr Rev. 1990 May;11(2):221–265. doi: 10.1210/edrv-11-2-221. [DOI] [PubMed] [Google Scholar]
  17. Seoud M. A., Johnson J., Weed J. C., Jr Gynecologic tumors in tamoxifen-treated women with breast cancer. Obstet Gynecol. 1993 Aug;82(2):165–169. [PubMed] [Google Scholar]
  18. Shattuck-Eidens D., McClure M., Simard J., Labrie F., Narod S., Couch F., Hoskins K., Weber B., Castilla L., Erdos M. A collaborative survey of 80 mutations in the BRCA1 breast and ovarian cancer susceptibility gene. Implications for presymptomatic testing and screening. JAMA. 1995 Feb 15;273(7):535–541. [PubMed] [Google Scholar]
  19. Shulman A., Cohen I., Altaras M. M., Maymon R., Ben-Nun I., Tepper R., Beyth Y. Ovarian cyst formation in two pre-menopausal patients treated with tamoxifen for breast cancer. Hum Reprod. 1994 Aug;9(8):1427–1429. doi: 10.1093/oxfordjournals.humrep.a138723. [DOI] [PubMed] [Google Scholar]
  20. Shushan A., Peretz T., Uziely B., Lewin A., Mor-Yosef S. Ovarian cysts in premenopausal and postmenopausal tamoxifen-treated women with breast cancer. Am J Obstet Gynecol. 1996 Jan;174(1 Pt 1):141–144. doi: 10.1016/s0002-9378(96)70386-1. [DOI] [PubMed] [Google Scholar]
  21. Spicer D. V., Pike M. C., Henderson B. E. Ovarian cancer and long-term tamoxifen in premenopausal women. Lancet. 1991 Jun 8;337(8754):1414–1414. doi: 10.1016/0140-6736(91)93096-r. [DOI] [PubMed] [Google Scholar]
  22. Terada S., Uchide K., Suzuki N., Akasofu K. A follicular cyst during tamoxifen therapy in a premenopausal breast cancer woman. Gynecol Obstet Invest. 1993;35(1):62–64. doi: 10.1159/000292666. [DOI] [PubMed] [Google Scholar]
  23. Whittemore A. S., Harris R., Itnyre J. Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies. II. Invasive epithelial ovarian cancers in white women. Collaborative Ovarian Cancer Group. Am J Epidemiol. 1992 Nov 15;136(10):1184–1203. doi: 10.1093/oxfordjournals.aje.a116427. [DOI] [PubMed] [Google Scholar]
  24. van Leeuwen F. E., Benraadt J., Coebergh J. W., Kiemeney L. A., Gimbrère C. H., Otter R., Schouten L. J., Damhuis R. A., Bontenbal M., Diepenhorst F. W. Risk of endometrial cancer after tamoxifen treatment of breast cancer. Lancet. 1994 Feb 19;343(8895):448–452. doi: 10.1016/s0140-6736(94)92692-1. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES