What is your approach to gynecologic examinations/surveillance in a standard risk patient on adjuvant tamoxifen?

In the absence of symptoms (abnormal bleeding or discharge, pain, etc.), I do not recommend gynecologic examinations/surveillance beyond what is appropriate given the woman's age. First, premenopausal women on tamoxifen are not at increased risk of developing endometrial cancer. In postmenopausal women on tamoxifen due to a contraindication to or poor tolerance of an AI, while some will develop thickening of the uterine lining there is no evidence that surveillance with ultrasound or endometrial biopsies is effective for early detection of endometrial cancer that will occur in about 1.2% of such women treated with tamoxifen for 5 years (and, unless neglected, is unlikely to cause mortality); in my experience, such 'surveillance' only create...