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Objective: Results of the Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial have shown that tamoxifen is associated with a significantly higher incidence of gynecologic adverse events than anastrozole., Study Design: This was a retrospective analysis of all gynecologic adverse events and interventions conducted in patients receiving anastrozole or tamoxifen in the main ATAC trial database., Results: Women taking tamoxifen experienced significantly more gynecologic adverse events than those taking anastrozole (34.2% vs 20.5%; P < .0001) and this led to more diagnostic and/or therapeutic interventions, including an almost 4-fold increase in the number of hysterectomies (5.1% vs 1.3%; P < .0001). The majority of the gynecologic adverse events with tamoxifen occurred during the first 2.5 years., Conclusion: The lower incidence of gynecologic adverse events and interventions with anastrozole and the early occurrence of these events provide further support for using anastrozole as the initial adjuvant treatment for early hormone receptor-positive breast cancer.

Objective: This study was undertaken to assess baseline endometrial molecular events in the ATAC (Arimidex, tamoxifen, alone, or in combination) trial of breast cancer adjuvant therapy., Study Design: Estrogen receptor (ER) and progesterone receptor (PR) levels and markers of cell proliferation (Ki67) and apoptosis ( Bcl -2) were assessed in 93 patients at baseline., Results: An inactive/atrophic endometrium was found in 63 patients, 5 had a proliferative endometrium, and 12 had a secretory endometrium. Thirteen endometrial polyps were analyzed. Inactive endometrium showed high levels of ER in the glandular epithelium, whereas in more than 50% of samples, PR expression was negative or low (+) in the glandular epithelium, and stroma. Ki67 expression was low in both the glandular epithelium and the stroma of the inactive endometrium, whereas Bcl -2 expression was mostly high or very high (+++/++++) in the glandular epithelium. Bcl -2 was strongly expressed (+++/++++) in the glandular epithelium of polyps., Conclusion: Although all patients were asymptomatic, some had endometrial pathology.