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Breast Cancer

Should Urogenital Atrophy in Breast Cancer Survivors Be Treated with Topical Estrogens?

^aDepartment of Hematology and Medical Oncology, Princess Margaret Hospital, Toronto, Canada; ^bDepartment of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Canada

Key Words. Breast cancer • Urogenital atrophy • Aromatase inhibitor • Tamoxifen • Estrogen replacement therapy • Toxicity

Correspondence: Mark Clemons M.D., Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada. Telephone: 416-946-4534; Fax: 416-946-2983; e-mail: mark.clemons{at}uhn.on.ca

Disclosure: The article discusses Replens® (Wellspring Pharmaceutical) as a vaginal lubricant/moisturizer and Estring® (Pfizer) and Vagifem® (Novo Nordisk) as topical estrogen replacements. W.W. has received an honorarium from Wyeth and Berlex as a guest speaker at CME events. No other potential conflicts of interest were reported by the authors, planners, reviewers, or staff managers of this article.

Breast cancer survivors represent a unique patient population with a high prevalence of menopausal symptoms. Given the improved longevity of cancer patients, the consequences of menopause have become an increasingly important and challenging management issue. To date, considerable attention has been paid to the management of menopausal vasomotor symptoms and bone health among breast cancer patients. As a result, numerous nonhormonal treatment options have been developed for the management of these issues. The treatment of urogenital symptoms among this population is poorly understood and relatively understudied. Although systemic or topical estrogen replacement is the most effective method for treating hypoestrogenemic urogenital symptoms, women with a prior diagnosis of breast cancer are cautioned from taking exogenous estrogens in order to avoid a potential contribution to recurrent breast cancer risk. This review focuses on the urogenital consequences of estrogen deprivation therapy in breast cancer patients and provides practitioners with a simple guide of current and future strategies for managing these symptoms.