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Tamoxifen-related bleeding — DRCOG MCQ

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HardGynaecological OncologyTamoxifen-related bleedingDRCOG

A 56-year-old taking tamoxifen after oestrogen-receptor-positive breast cancer has been amenorrhoeic for three years and now has spontaneous vaginal bleeding. Speculum examination is normal. What is the best primary-care action?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Refer through the suspected-cancer pathway for endometrial assessment

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as E

E is correct. She is over 55 with unexplained postmenopausal bleeding, so NICE NG12 requires suspected-cancer-pathway referral. Tamoxifen increases concern for endometrial pathology but does not turn a symptom-led referral into a primary-care thickness algorithm. A may form part of secondary-care assessment, yet making referral depend on a 4 mm cut-off is unreliable in tamoxifen users and delays care. B withdraws beneficial cancer therapy without resolving the diagnostic obligation. C uses screening to investigate bleeding and addresses the cervix rather than the endometrium. D follows an ovarian pathway despite a uterine symptom and normal examination.

Reference: NICE NG12: Suspected cancer—breast and gynaecological cancer referral recommendations: https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer