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December 2024 | George M. Pikler, M.D., Ph.D., FACP, Lead Oncology Advocate N1X10

Safety of Vaginal Estrogen Therapy in Women With a History of Breast Cancer

Many women with breast cancer experience symptoms of genitourinary syndrome of menopause, such as vaginal itchiness, burning, pain with sexual activity, and urinary incontinence. These symptoms may be precipitated by endocrine treatments and contribute to noncompliance with endocrine therapy. Vaginal estrogen therapy is an effective treatment for genitourinary syndrome of menopause.

Clinical trials have reported increased recurrence in patients with breast cancer who received systemic hormone replacement therapy (HRT). A recent trial observed a small increase in serum estradiol with use of a vaginal estradiol tablet (10 μg).

In a large (1), claims-based analysis, conducted between January 2009 to June 2022, researchers at Johns Hopkins in Baltimore, Maryland and the University of Texas Medical Branch, Galveston, Texas, 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.

A recent study (2) investigated vaginal estrogen therapy and breast cancer–specific mortality in 2 large, contemporary population-based breast cancer cohorts. The study aimed to determine whether the risk of breast cancer–specific mortality was higher in females with breast cancer who used vaginal estrogen therapy vs females with breast cancer who did not use HRT. The study showed no evidence that vaginal estrogen therapy was associated with increased risk of early breast cancer–specific mortality. A recent Swedish case-control study showed no increase in breast cancer–specific mortality in patients with breast cancer who used estrogen but did not distinguish between vaginal or systemic estrogen.

In the absence of trials of vaginal estrogen therapy in breast cancer, the findings of this study provide some reassurance that patients with breast cancer who received vaginal estrogen therapy were not at a markedly higher risk of breast cancer–specific mortality and appear to support national guidelines suggesting that vaginal estrogen therapy can be considered for genitourinary symptoms if nonhormonal treatments are unsuccessful.

(1) Obstetrics & Gynecology. 2023; 142 (3): 660-668
(2) JAMA Oncology. 2024; 10 (1): 101-108
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Erica

Erica Cross, PA

PA

Erica is a board certified Physician Assistant. She obtained her Master’s degree in Physician Assistant studies from Our Lady of the Lake College in Baton Rouge, LA. She began practicing in 2011 and has worked clinically in Orthopedics and Dermatology. The majority of her career has been spent in a Dermatology practice where she assisted in Mohs surgery, treating various types of skin cancer. She also teaches in the medical simulation department at the University of South Alabama and enjoys every aspect of medical education.