ACOG committee opines in favor of using vaginal estrogen in Breast Cancer Survivors.

The American College of Obstetricians and Gynecologists’ (ACOG) Committee on Gynecologic Practice advocated in favor of using vaginal estrogen in  breast cancer survivors in forthcoming march issue of  Obstetrics & Gynecology: (March 2016 - Volume 127 - Issue 3 - p e93–e96) .

In general population, systemic and vaginal estrogen preparations are in wide use for relief of vasomotor symptoms, Lower UTI, vaginal atrophy and dysparunia.

However, some cancers are hormone sensitive creating a safety issue specially in those patients who have breast cancer or are breast cancer survivors.

Healthcare providers are becoming increasingly aware of the need to address female-specific survivorship issues especially the urogenital symptoms arising due to hypoestrogenic state because of cancer surgeries or natural menopause in survivors.

Nonhormonal methods like moisturizers, lubricants, and topical anesthetics, are always the  first-line of treatment   for urogenital symptoms or atrophy-related urinary symptoms experienced by women during or after treatment for breast cancer but in some women these treatment have temporary or limited effect.

Studies have shown that low dose vaginal estrogen are devoid of systemic side effects caused by oral preparations, because of minimum absorption and levels attained in blood comparable to natural menopause.

Options include creams, ring and vaginal tablets. The data regarding 17β-estradiol (commonly referred to as estradiol) cream is more robust than data on creams with conjugated equine estrogen because of heterogeneity of the formulation.

Controversy exists in use of vaginal estrogen in those women with breast cancer using aromatase inhibitor. Such women may benefit from the short-term use of estrogen to improve symptoms, followed by a return to normal aromatase inhibitor therapy for the duration of the treatment course.  On the other hand women on Tamoxifen can safely use vaginal estrogen preparation.

The committee also advocates that treatment should be tailored to each patient depending upon the need, therapy received and hormonal status of the cancer cells.

The treatment should always be initiated in coordination with the woman’s oncologist. It should also be preceded by informed decision making explaining the risk benefit ratio.

When a final decision regarding prescription is made, it should be prescribed in the lowest dose to relieve vaginal symptoms and for minimum amount of time.

References:

http://journals.lww.com/greenjournal/Fulltext/2016/03000/Committee_Opinion_No__659___The_Use_of_Vaginal.43.aspx