Vaginal estrogen safe and effective in women with genitourinary syndrome of menopause with breast cancer
Though vaginal estrogen therapy is safe and effective in women with genitourinary syndrome of menopause (GSM) alongside breast cancer, only a few women use it, according to a recent study published in the Journal of Urology.
Systemic therapies for breast cancer-selective estrogen receptor modulators (SERM), aromatase inhibitors (AI), and chemotherapies - can result in a genitourinary syndrome of menopause (previously recognized as vulvovaginal atrophy) for up to 70% of postmenopausal breast cancer survivors. While systemic estrogen therapy is often avoided in these women, vaginal estrogen can be safely used to treat GSM symptoms. Our objective is to assess the use of vaginal estrogen for women diagnosed with GSM and a personal history of breast cancer using a large US claims database.
The TriNetX Diamond network database was queried: a US health research network of 190 million patients, encompassing healthcare encounters and prescriptions between 2009-2021. Females diagnosed with postmenopausal atrophic vaginitis or atrophy of the vulva (ICD-10 N95.2, N90.5) were included. Of these, women with breast cancer (C50 or Z86.000) were included if the diagnosis was at least 1 month before VVA diagnosis. Estrogen receptor status was collected when available (ICD-10 Z17.0, Z17.1). Prescriptions for treatment of GSM were included if prescribed on the day of VVA diagnosis up to 1 year after index diagnosis. Incidence of vaginal estrogen use in patients with a history of breast cancer was determined for 2013-2015, 2016-2018, and 2019 to the present.
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