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Topical estrogen prescribing patterns for urogenital atrophy among women with breast cancer

results of a national provider survey

Richter, Lee A. MD1; Han, Jim MS2; Bradley, Sarah MD1; Lynce, Filipa C. MD3; Willey, Shawna C. MD4; Tefera, Eshetu MS5; Pollack, Craig E. MD, MHS6

doi: 10.1097/GME.0000000000001311
Original Articles

Objective: The aim of the study was to evaluate knowledge, attitudes, and practice patterns of physicians prescribing topical estrogen for women with urogenital atrophy and a history of breast cancer.

Methods: A cross-sectional survey of breast surgeons, urogynecologists, and gynecologists was distributed via their professional societies: the American Society of Breast Surgeons (ASBrS), the American Urogynecologic Society (AUGS), and the Society of Gynecologic Surgeons (SGS). Providers reported level of comfort prescribing vaginal estrogen for urogenital symptoms for women with different categories of breast cancer and current treatment: estrogen receptor (ER) negative, ER positive no longer on endocrine therapy, and ER positive currently on adjuvant endocrine therapy. General knowledge questions assessed agreement on a 5-point Likert scale to statements about vaginal estrogen safety and pharmacology.

Results: A total of 820 physicians completed the survey: 437 responses from the ASBrS (response rate, 26.7%), 196 from AUGS (15%), and 187 from SGS (44.5%). The majority of physicians (84%), regardless of specialty, felt comfortable prescribing vaginal estrogen to women with a history of ER-negative cancer: 65.7% felt comfortable prescribing for women with ER-positive breast cancer no longer on endocrine therapy; 51.3% for women on an aromatase inhibitor; and 31.4% for women on tamoxifen. Urogynecologists were significantly more comfortable than breast surgeons prescribing vaginal estrogen for the lowest risk patients, whereas breast surgeons had the highest level of comfort for women currently on endocrine therapy.

Conclusions: This study highlights heterogeneity in practice patterns both within and across specialties. The clinical variation seen in this study suggests providers may benefit from increased knowledge regarding vaginal estrogen.

1MedStar Washington Hospital Center, Division of Urogynecology, Washington, DC

2Georgetown University School of Medicine, Washington, DC

3MedStar Georgetown University Hospital, Department of Oncology, Washington, DC

4MedStar Georgetown University Hospital, Department of Surgery, Washington, DC

5MedStar Health Research Institute, Washington, DC

6Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Address correspondence to: Lee A. Richter, MD, National Center for Advanced Pelvic Surgery, MedStar Washington Hospital Center, 106 Irving Street NW, POB 405 South, Washington, DC 20010. E-mail:

Received 11 October, 2018

Revised 13 December, 2018

Accepted 13 December, 2018

Funding/support: Financial support for this project was provided by a MedStar New Investigator Grant.

Financial disclosure/conflicts of interest: CEP reports stock ownership in Gilead Pharmaceuticals. FCL receives funding from Pfizer. The authors have no other conflict of interest or financial disclosures.

© 2019 by The North American Menopause Society.