Survey shows limited awareness of tamoxifen-associated uterine cancer risk among breast cancer survivors

Abstract Background Tamoxifen is a cornerstone of endocrine treatment for hormone receptor-positive breast cancer, reducing recurrence and breast cancer-specific mortality. However, its use is associated with a small, yet clinically relevant, increase in uterine cancer. As diagnosis of this cancer remains symptom-triggered, it is essential for patients to be aware of this risk and report symptoms promptly for optimal outcomes. We therefore assessed risk awareness among breast cancer survivors while exploring their attitudes towards potential future endometrial surveillance strategies. Methods Over a 10-month period, a web-based survey was conducted among breast cancer survivors with/without tamoxifen treatment. The mixed-format questionnaire included closed-ended questions and optional free-text comments. Quantitative data were summarized descriptively and analyzed statistically; qualitative responses were reviewed thematically to contextualize survey findings. Results Of 163 respondents, 154 breast cancer survivors were included in the analysis, 128 of whom had received tamoxifen. Among tamoxifen-associated participants, 60% reported insufficient awareness of the associated uterine cancer risk, and half expressed uncertainty about the adequacy of the current symptom-triggered endometrial evaluation. Despite this, acceptance of tamoxifen therapy was high; only one patient declined treatment over concerns about side effects. Almost all participants (96%) were willing to adopt endometrial surveillance methods, if developed and validated. Conclusion As evaluation of tamoxifen-associated uterine pathology is symptom-triggered, our data highlight the need for improved and standardized risk communication to promote timely symptom recognition, reporting, and diagnostic evaluation. Moreover, our findings support incorporating patient-reported preferences into the development of future endometrial detection strategies to improve survivorship care.