Women who have estrogen-dependent breast cancer are advised to avoid the hormone as a precautionary measure against recurrence of the disease. Gynecologists, however, do not think that topical vaginal estrogen poses this risk to breast cancer survivors.
On Monday, the American College Of Obstetricians and Gynecologists said that topical vaginal estrogen does not seem to pose breast cancer recurrence risks and green-lights use of topical estrogen to relieve symptoms such as urinary tract infection and painful sex.
Vaginal and urologic symptoms such as vaginal dryness, bleeding, pain, bacterial infections and painful sex often arise during menopause, but these symptoms are often exacerbated in women getting treatment for estrogen-dependent breast cancer.
Diana Nancy Contreras from the NYU Langone Medical Center says that while there are only relatively small studies on vaginal estrogen, overall data suggests the treatment is safe.
Oral hormone treatments have been associated with increased risks for cancer, but vaginal estrogen is used at a lower dose and does not travel through the body as its oral counterpart.
No evidence has also emerged showing that vaginal estrogen more likely triggers cancer in patients with history of estrogen-dependent cancer.
Contreras adds that the treatment may not be best for everyone, but it should at least be an option for those who have severe situations that may prompt them to come off of their meds.
The opinion published in Obstetrics & Gynecology, however, stresses that women with history of estrogen-dependent breast cancer should only turn to vaginal estrogen if nonhormonal options, such as lubricants, do not work.
"Among women with a history of estrogen-dependent breast cancer who are experiencing urogenital symptoms, vaginal estrogen should be reserved for those patients who are unresponsive to nonhormonal remedies," reads the committee opinion. "Treatment should be individualized based on each woman's risk-benefit ratio and clinical presentation."
The committee likewise recommends that vaginal estrogen should be prescribed to breast cancer patients at the lowest dose to affect vaginal symptoms and for a limited period of time until signs of symptoms improvement become apparent. Patients should also coordinate with their oncologist when deciding to use vaginal estrogen.
