The American College of Obstetricians and Gynecologists (ACOG) Committee of Gynecologic Practice has issued recommendations on the use of vaginal estrogen in women with a history of estrogen-dependent breast cancer. The committee opinion is intended to address the safety concerns about the use of local hormone therapy in women who currently have breast cancer or have a history of breast cancer. The ACOG makes the following recommendations and conclusions:
• Nonhormonal approaches are the first-line choices for managing urogenital symptoms or atrophy-related urinary symptoms experienced by women during or after treatment for breast cancer.
• 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.
• The decision to use vaginal estrogen may be made in coordination with a woman’s oncologist. Additionally, it should be preceded by an informed decision-making and consent process in which the woman has the information and resources to consider the benefits and potential risks of low-dose vaginal estrogen.
• Data do not show an increased risk of cancer recurrence among women currently undergoing treatment for breast cancer or those with a personal history of breast cancer who use vaginal estrogen to relieve urogenital symptoms.
Citation: The use of vaginal estrogen in women with a history of estrogen-dependent breast cancer. Committee Opinion No. 659. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2016;127:393-6.