Vaginal estrogen and mammogram results: case series and review of literature on treatment of genitourinary syndrome of menopause (GSM) in breast cancer survivors

Zuo, Stephanie W.; Wu, Harold; Shen, Wen

doi:10.1097/gme.0000000000001079

Cited by 5 publications

(2 citation statements)

References 57 publications

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“…In one small, single-institution study of 20 postmenopausal patients, of whom three had a history of breast cancer, the authors found no new cancer or cancer recurrence after at least 1 year of vaginal estrogen use. 19 A large nested case-control study found no increased relative risk of cancer recurrence with the use of local estrogen during concurrent use of tamoxifen or aromatase inhibitors or after treatment with these medications. 20 A recent Danish cohort study of 8,461 women described no increased risk of recurrence or mortality in postmenopausal women with a history of early-stage breast cancer after treatment with vaginal estrogen therapy or menopausal hormone therapy.…”

Section: Discussionmentioning

confidence: 99%

Safety of Vaginal Estrogen Therapy for Genitourinary Syndrome of Menopause in Women With a History of Breast Cancer

Agrawal

Singh

Able

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To assess the risk of recurrence of breast cancer associated with vaginal estrogen therapy in women diagnosed with genitourinary syndrome of menopause with a history of breast cancer using a large U.S. claims database. METHODS: A U.S. health research network (TriNetX Diamond Network) was queried from January 2009 to June 2022. Our cohort consisted of women diagnosed with breast cancer within 5 years before the initial genitourinary syndrome of menopause diagnosis. Patients with active disease, defined as those undergoing mastectomy, radiation treatment, or chemotherapy within 3 months before diagnosis of genitourinary syndrome of menopause, were excluded. Recurrence was defined as mastectomy, radiation, chemotherapy, or secondary malignancy within 3 months to 5 years after the initiation of vaginal estrogen therapy for genitourinary syndrome of menopause. The study cohort included those with three or more vaginal estrogen prescriptions. The control cohort included women with breast cancer without any vaginal estrogen prescriptions after genitourinary syndrome of menopause diagnosis. Propensity matching was performed. A subanalysis by positive estrogen receptor status, when available, was performed. RESULTS: We identified 42,113 women with a diagnosis of genitourinary syndrome of menopause after breast cancer diagnosis with any estrogen receptor status, 5.0% of whom received vaginal estrogen. Of the initial cohort, 10,584 patients had a history of positive estrogen receptor breast cancer, and 3.9% of this group received vaginal estrogen. Risk of breast cancer recurrence was comparable between those who received vaginal estrogen and those who did not in both the any estrogen receptor (risk ratio 1.03, 95% CI 0.91–1.18) and positive estrogen receptor (risk ratio 0.94, 95% CI 0.77–1.15) status analyses. CONCLUSION: In a large, claims-based analysis, we did not find an increased risk of breast cancer recurrence within 5 years in women with a personal history of breast cancer who were using vaginal estrogen for genitourinary syndrome of menopause.

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Section: Discussionmentioning

confidence: 99%

Safety of Vaginal Estrogen Therapy for Genitourinary Syndrome of Menopause in Women With a History of Breast Cancer

Agrawal

Singh

Able

et al. 2023

Obstetrics &Amp; Gynecology

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“…These studies included women taking tamoxifen and women taking AIs and had varied follow-up time. Additionally, no change in breast density or Bi-RADS scores was observed in a cohort study of menopausal women after 1 year of estrogen use (53).…”

Section: Hormonal Treatment Optionsmentioning

confidence: 99%

Treatment of Urogenital Symptoms in Individuals With a History of Estrogen-dependent Breast Cancer

2021

Obstetrics &Amp; Gynecology

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SUMMARY With an estimated 3.8 million breast cancer survivors in the United States, obstetrician–gynecologists often are on the front lines of addressing survivorship issues, including the hypoestrogenic-related adverse effects of cancer therapies or early menopause in survivors (1). Although systemic and vaginal estrogen are used widely for symptomatic relief of genitourinary syndrome of menopause in the general population, among individuals with a history of hormone-sensitive cancer, there is uncertainty about the safety of hormone-based therapy, leading many individuals with bothersome symptoms to remain untreated, with potential negative consequences on quality of life (2). An effective management strategy requires familiarity with a range of both hormonal and nonhormonal treatment options, knowledge about the pharmaceutical mechanisms of action, and the ability to tailor treatment based on individual risk factors. This clinical consensus document was developed using an a priori protocol in conjunction with two authors specializing in urogynecology and gynecologic oncology. This document has been updated to review the safety and efficacy of newer hormonal treatment options as well as nonhormonal modalities.

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Menopause Management

Williams

2021

Challenges in Older Women’s Health

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Vaginal estrogen and mammogram results: case series and review of literature on treatment of genitourinary syndrome of menopause (GSM) in breast cancer survivors

Cited by 5 publications

References 57 publications

Safety of Vaginal Estrogen Therapy for Genitourinary Syndrome of Menopause in Women With a History of Breast Cancer

Safety of Vaginal Estrogen Therapy for Genitourinary Syndrome of Menopause in Women With a History of Breast Cancer

Treatment of Urogenital Symptoms in Individuals With a History of Estrogen-dependent Breast Cancer

Menopause Management

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