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Vaginal estrogen and mammogram results

case series and review of literature on treatment of genitourinary syndrome of menopause (GSM) in breast cancer survivors

Zuo, Stephanie Wang MD1; Wu, Harold MD2; Shen, Wen MD, MPH2

doi: 10.1097/GME.0000000000001079
Brief Report

Objective: To examine mammographic density before and after at least 1 year of vaginal estrogen use in a small cohort of healthy postmenopausal women and women with a personal history of breast cancer.

Methods: We extracted data via chart review of patients from a single practitioner's menopause specialty clinic in Baltimore, MD. Mammographic change was primarily determined via the Bi-RADS scoring system, including the Bi-RADS density score. In addition, we conduct a narrative review of the current literature on the usage of local estrogen therapy, and systemic and local alternatives in the treatment of genitourinary syndrome of menopause (GSM) in breast cancer survivors.

Results: Twenty healthy postmenopausal women and three breast cancer survivors fit our inclusion criteria. Amongst these two groups, we did not find an increase in mammographic density after at least 1 year and up to 18 years of local vaginal estrogen. Ospemifene use in one patient did not appear to be associated with any change in Bi-RADS score. Our narrative review found little data on the effects of vaginal estrogen therapy or newer alternative systemic therapies such as ospemifene on mammographic density.

Conclusions: Low-dose vaginal estrogen use for 1 or more years in a small cohort of women with GSM did not appear to be associated with any changes in breast density or Bi-RADS breast cancer risk scores in the majority of study participants, including three breast cancer survivors. Larger long-term controlled clinical trials should be conducted to examine the effects of low-dose vaginal estrogen on mammographic density in women with and without a personal history of breast cancer. Furthermore, relative efficacy and risk of vaginal estrogen compared with other forms of treatment for GSM should also be studied in long-term trials.

1Albert Einstein College of Medicine, Department of Obstetrics and Gynecology, Bronx, NY

2Johns Hopkins School of Medicine, Department of Gynecology and Obstetrics, Baltimore, MD.

Address correspondence to: Wen Shen, MD, MPH, Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287. E-mail:

Received 14 September, 2017

Revised 17 January, 2018

Accepted 17 January, 2018

Disclaimer: A preliminary version of this paper was presented as a poster at the 2016 meeting of The North American Menopause Society in Orlando, FL.

Funding/support: None reported.

Financial disclosure/conflicts of interest: Dr Wen Shen received funding from Pfizer, Inc. and JI Foundation, Inc. to develop menopause education curricula. For the remaining authors, no conflicts of interests or sources of funding are declared.

© 2018 by The North American Menopause Society.