Vulvovaginal atrophy (VVA) in breast cancer survivors (BCS) is still an unmet medical need: results of an Italian Delphi Panel

Abstract

Purpose VVA is a common disease, with approximately 50% of all postmenopausal women having related symptoms. VVA has a significant impact on the personal and sexual lives and on many aspects of women's self-esteem and emotional well-being. It is particularly frequent and severe in patients treated for BC, where it originates significant economic and social costs. Given the lack of published evidence on this subject, a Delphi Panel was carried out to evaluate: & The epidemiology of VVA and of its risk-factors/comorbidities in Italy & The present standard of care and unmet medical needs & The comparison between recent US epidemiological data and the Italian situation & The health resources used in VVA BC The burden of illnessDespite the considerable negative impact on quality of life, a disparity between the high prevalence of this condition and the infrequent clinical diagnosis is documented in medical practice and in surveys. This inaccuracy is thought to be primarily a consequence of patients' unwillingness and/or reluctance to report symptoms in the clinical setting and of health-care professional's difficulty in approaching this sensitive topic during routine consultations.

Sexual Dysfunction in Postmenopausal Women with Breast Cancer on Adjuvant Aromatase Inhibitor Therapy

“…Considering the higher anxiety levels of AI patients, they should be actively informed that sexual dysfunction, that has also a relevant social cost [31], will improve after AI stopping and could be safely and effectively treated with nonhormonal treatments, like ospemifene [32]. While waiting, it is important to suggest trying to empower them telling that they can do something important even during AI use to keep up sexual activity.…”

Hyaluronic Acid: A Valid Therapeutic Option for Early Management of Genitourinary Syndrome of Menopause in Cancer Survivors?

“…Estrogen deficiency induces similar atrophic changes also in the urinary tract, where estrogen receptors are abundantly expressed [ 16 , 22 ]. Consequently, women with GSM often suffer from urinary symptoms such as recurrent infections, incontinence, urgency, and dysuria [ 5 , 17 , 23 ]. Other anatomical and physiological changes in urogenital tissues include that the vagina may shrink, shorten, and lose its elasticity and flexibility.…”

Genitourinary Symptoms in Breast Cancer Survivors: Prevalence, Correlates, and Relationship With Sexual Functioning

“…Although genitourinary symptoms are usually caused by naturally occurring postmenopausal estrogen loss, they also can be caused by chemotherapy and/or endocrine therapy for breast cancer (Mac Bride, Rhodes, & Shuster, 2010; The North American Menopause Society, 2020). Breast cancer survivors suffer from genitourinary symptoms, yet they are under-reported (Baumgart et al, 2011), under-assessed, and under-treated (Biglia, Pup, Masetti, Villa, & Nappi, 2020;Cook, Sutherland, Baum, Schover, & Newman, 2018;Lester & Bernhard, 2009;Moral et al, 2018).…”

“…In addition, the prevalence of genitourinary symptoms varies due to differences in symptom assessments. In prior studies of breast cancer survivors, 32% to 75% reported at least one genitourinary symptom such as vaginal discharge, irritation, bleeding, dryness, and urine control problems (Baumgart et al, 2011;Biglia et al, 2020;Chin et al, 2009;Lester, Bernhard, & Ryan-Wenger, 2012). Many of these studies with selected samples suggested the need for a large sample estimate in a group of women unselected for symptoms of any kind.…”