Obstet Gynecol. 2016 Mar;127(3):e93-e96. doi: 10.1097/AOG.0000000000001351.
Cancer treatment should address female-specific survivorship issues, including the hypoestrogenic- related adverse effects of cancer therapies or of natural menopause in survivors. Systemic and vaginal estrogen are widely used for symptomatic relief of vasomotor symptoms, sexual dysfunction, and lower urinary tract infections in the general population. However, given that some types of cancer are hormone sensitive, there are safety concerns about the use of local hormone therapy in women who currently have breast cancer or have a history of breast cancer. 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.
癌症治疗应该针对女性特有的生存问题，包括癌症治疗或幸存者自然绝经引起的低雌激素相关不良影响。全身和阴道雌激素广泛用于缓解普通人群的血管舒缩症状、性功能障碍和下尿路感染的症状。然而，鉴于某些类型的癌症对激素敏感，对于目前患有乳腺癌或有乳腺癌病史的女性，局部激素治疗的安全性存在担忧。对于在乳腺癌治疗期间或之后经历泌尿生殖系统症状或与萎缩相关的尿症状的女性，非激素方法是管理这些症状的首选方法。对于经历泌尿生殖系统症状的有雌激素依赖性乳腺癌病史的女性，阴道雌激素应保留给对非激素治疗无反应的患者。使用阴道雌激素的决定可以与女性的肿瘤医生协调做出。此外，在做出决定之前，应该进行知情决策和同意过程，让女性有信息和资源来考虑使用低剂量阴道雌激素的益处和潜在风险。数据显示，正在接受乳腺癌治疗的女性或有乳腺癌个人病史的女性使用阴道雌激素缓解泌尿生殖系统症状，不会增加癌症复发的风险。
