Vaginal estrogen therapy for treatment of menopausal genitourinary syndrome among breast cancer survivors: a systematic review and meta-analysis.

OBJECTIVE

Assess survival outcomes and risk of recurrence in vaginal estrogen therapy (VET) users with medical history of breast cancer.

DATA SOURCE

The search strategy was guided by standardized terms and keywords were identified from controlled vocabularies. Following databases were used for literature search: Pubmed, EMBASE, Cochrane, Scopus and Web of Science. Only studies published in the 21st century (2001-present) and written in English were included.

STUDY SELECTION

A total of 988 records were reviewed by two independent authors. After full-text analysis of 38 of them, 7 articles were included in the meta-analysis.

DATA COLLECTION

Data from eligible studies were extracted and tabulated based on predefined criteria: author, country, year, study type, sample size, type of intervention, use of aromatase inhibitors, duration of follow-up, and main outcomes.

RESULTS

118.659 breast cancer survivors were analyzed, of whom 6.358 were treated with VET. The overall analysis showed no significant increase in the risk of recurrence (RR = 0.87, 95%CI: 0.67-1.11). VET users had a significant reduction in all-cause mortality (RR = 0.80, IC95%: 0.75-0,86).

CONCLUSION

Vaginal estrogen therapy appears to be safe in the management of menopausal genitourinary syndrome in breast cancer survivors and it is related to significantly lower all-cause mortality.

PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS PROSPERO

CRD42024602047.