Meet the Expert
Breast cancer and Menopause Hormone Therapy : Do Topical estrogen increase the risk of Breast cancer ? Serge Rozenberg Department of Gynaecology-Obstetrics, CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium Introduction : How often did it occur that you prescribed a topical (vaginal) estrogen and that your patient didn’t take it, after reading the patient information, out of fear for breast cancer ? This review will discuss whether an increased breast cancer risk is documented. The second talk by Dr Camil Castelo-Branco will cover the approach to vulvo-vaginal atrophy (VVA) in breast cancer survivors. Local estrogen therapy is the most effective treatment for moderate to severe symptoms of VVA. Moreover it is associated with a reduced risk of urinary tract infections and overactive bladder urgency. The currently available agents include estriol (a weak estrogen, that is not converted to estradiol), estradiol and conjugated estrogens. Using the suggested doses doses, these drugs barely increase serum levels of estrogens. It is therefore unlikely that vaginal estrogens increase the risk of developing breast cancer. In Bresat cancer survivors, using aromatase inhibitors (AI), the aim of AI therapy is to reduce as much as possible the serum estrogen levels. For this reason are vaginal estrogens not indicated as a first line therapy in breast cancer patients using AI.