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Question answered:31/01/08 Warning! this question is over two years old.
The NLH Q&A service has answered a number of questions on the use of topical oestrogen for vaginal dryness in patients with a history of breast cancer. They all state that topical oestrogen is contraindicated in a patient with known, suspected or past history of breast cancer.
http://www.clinicalanswers.nhs.uk/index.cfm?question=3420
http://www.clinicalanswers.nhs.uk/index.cfm?question=4280
http://www.clinicalanswers.nhs.uk/index.cfm?question=1034
The NLH Q&A service answered the following question in October 2007, “In patients with a family history of premenopausal breast cancer is there any increased risk by using topical oestrogen therapy?”
In their answer they state:
“Our literature search identified just two studies investigating the risk of breast cancer in patients using topical vaginal oestrogen. However, in both studies the risk factor being evaluated was a personal risk or recurrence of breast cancer due to use of the topical oestrogen not the possible additional risk of having a family history of breast cancer.
The Medline abstracts of a study by Lyytinen et al reads:
“METHODS: All Finnish women older than age 50 years using oral or transdermal estradiol (n=84,729), oral estriol (n=7,941), or vaginal estrogens (n=18,314) for at least 6 months during 1994-2001 were identified from the national medical reimbursement register. They were followed for breast cancer with the aid of the Finnish Cancer Registry to the end of 2002… CONCLUSION: Estradiol for 5 years or more, either orally or transdermally, means 2-3 extra cases of breast cancer per 1,000 women who are followed for 10 years. Oral estradiol use for less than 5 years, oral estriol, or vaginal estrogens were not associated with a risk of breast cancer. LEVEL OF EVIDENCE: II-2.” [3]
Dew et al examined the risk of recurrence breast cancer associated with the use of topical vaginal oestrogen. They report:
“METHODS: The study group comprised 1472 women with histologically confirmed breast cancer. In 69 of these subjects (4.7%) their only bothersome menopausal problems were vaginal symptoms. In these women, poorly absorbed topical vaginal estrogen cream or tablets were used. The response of these patients was compared with that of the rest of the database… RESULTS: Hormone usage was entered as a time-dependent covariate with disease-free interval as the outcome. Subjects who used a topical estrogen alone for menopausal symptoms had an uncorrected hazard ratio of 0.30 (95% confidence interval (CI) 0.11-0.80, p = 0.02). The corrected hazard ratio was 0.57 (95% CI 0.20-1.58, p = 0.28). The hazard rate for a subject dying was not analyzed, as there were too few numbers. CONCLUSIONS: Although the small numbers of this study preclude a definitive result, topical estrogen usage does not appear to be associated with an increased risk of recurrence of breast cancer." [4]”
- http://www.clinicalanswers.nhs.uk/index.cfm?question=6357
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