2.A 54-year-old woman comes to the physician for an annual examination. She has no complaints. For the past year, she has been taking tamoxifen for the prevention of breast cancer. She was started on this drug after her physician determined her to be at high risk on the basis of her strong family history, nulliparity, and early age at menarche. She takes no other medications. Examination is within normal limits. Which of the following is this patient most likely to develop while taking tamoxifen? a) Breast cancer b)Elevated LDL cholesterol c)Endometrial changes d)Myocardial infarction e)Osteoporosis 2) Explanation: The correct answer is C C. Tamoxifen is a nonsteroidal agent with both pro- and antiestrogenic properties. It was first approved in 1977 by the U.S. Food and Drug Administration for use in postmenopausal women with advanced breast cancer. Since that time, it has been approved for many other uses related to breast cancer: as adjuvant therapy in postmenopausal women with resected node-positive disease, in postmenopausal women with metastatic breast cancer, and as adjuvant therapy in women (pre- and postmenopausal) with resected node-negative disease. Recently, much attention has been focused on its use for breast cancer prevention. There is evidence that women at high risk for the development of breast cancer may reduce their risk by taking tamoxifen. However, although tamoxifen appears to be antiestrogenic at the level of the breast, it appears to act in a proestrogenic fashion at the level of the endometrium. Many women on tamoxifen will develop endometrial changes, including polyp formation, hyperplasia, and frank invasive carcinoma. Thus, women on tamoxifen need to be followed carefully, and prompt evaluation of abnormal vaginal bleeding should be conducted. Tamoxifen is used to prevent breast cancer (choice A). Tamoxifen, like estrogen, has been shown to lower blood levels of LDL cholesterol (choice B). Women on tamoxifen appear to be at no greater risk, and may be at a lower risk, for the development of myocardial infarction (choice D). Tamoxifen, like estrogen, has been shown to increase bone density and to reduce the likelihood of development of osteoporosis (choice E)
Posted on: Sun, 25 Jan 2015 09:44:43 +0000
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