ablation vs hysterectomy & tamoxifen

Perimenopausal breast cancer survivor on tamoxifen.  After 4 months, diagnosed with AUB due to simple hyperplasia and polyps.  Given a choice of hysterectomy or Ablation.  Can't find any literature regarding ablation followup care since tamoxifen would be continued for 2-3 more years.  What is the risk of endometrial carcinoma or other gyn issues after ablation since tamoxifen would still be providing an estrongenic effect?

[Keith Downing, MD]

Hello,

The problem with ablation is that it does not alter your risk of endometrial cancer and could possibly lead to an occult cancer that does not result in bleeding (bleeding typically being the first sign of endometrial cancer that allows for early intervention).  Hysterectomy would eliminate this risk.  

There is very little literature regarding ablation and Tamoxifen.  The studies that have been conducted have had few patients and only short term follow up.  

So, if you underwent an ablation you would be entering unknown territory in terms of your cancer risk and deciding how best to follow you knowing you may not present with bleeding, and blind biopsies may not be as accurate.  

Best regards,

Dr. Downing