ACOG Supports the Use of Estrogen for Breast Cancer Survivors

Washington, DC—With 2 million breast cancer survivors now living in the United States, there is growing recognition among health care providers that quality of life issues for these women should be assessed and treated.

Today, in a new Committee Opinion, "The Use of Vaginal Estrogen in Women with a History of Estrogen-Dependent Breast Cancer," the American College of Obstetricians and Gynecologists (ACOG) outlines the options and treatments for female-specific survivorship issues. One particular challenge for providers to understand and address are vaginal symptoms of menopause, whether naturally occurring or treatment-induced.

Many therapies that treat estrogen-dependent breast cancer cause vaginal atrophy and increase symptoms of vaginal dryness, bleeding, bacterial infections and painful sex. These symptoms may worsen over time and, as women live longer, may pose significant challenges. It is estimated that up to 20% of all patients terminate or consider terminating therapies due to the severe detrimental effect that vaginal atrophy poses on their quality of life.

According to the new Committee Opinion, for women with estrogen-dependent breast cancer or a history of estrogen-dependent breast cancer, non-hormonal options for vaginal atrophy should be the first choice. However, health practitioners may now consider topical estrogen therapy for patients with a history of estrogen-dependent breast cancer who are unresponsive to non-hormonal remedies. Although there is controversy related to the risk of topical estrogen therapy and breast cancer recurrence, the Committee Opinion notes that data show there is no increased risk of cancer recurrence with the use of topical vaginal estrogen.

Diana Nancy Contreras, MD, Chair of ACOG's Subcommittee on Gynecologic Oncology, stated, "These new recommendations are especially important and helpful because they provide the patient with the information needed to make an informed decision with the input of her health care provider."

Committee Opinion #659, "The Use of Vaginal Estrogen in Women with a History of Estrogen-Dependent Breast Cancer," is published in the March issue of Obstetrics & Gynecology.

For more information see Practice Bulletin #126, "Management of Gynecologic Issues in Women With Breast Cancer."

Other recommendations issued in the March Obstetrics & Gynecology:

Task Force Report: Collaboration in Practice: Implementing Team-Based Care

Committee Opinion # 660, "Family Building Through Gestational Surrogacy"

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 58,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org