From the Guidelines
Estradiol vaginal cream can be considered safe for patients with a history of breast cancer, particularly those with hormone-receptor positive breast cancer, as a large cohort study of almost 50,000 patients with breast cancer followed for up to 20 years showed no evidence of a higher risk of breast cancer-specific mortality in those using vaginal estrogen 1. However, it is essential to weigh the benefits and risks of using estrogen-containing products in breast cancer survivors, as the potential stimulation of residual cancer cells is a concern. The use of vaginal estrogen has been shown to be effective in treating vaginal dryness, itching, discomfort, and painful intercourse in postmenopausal individuals, including breast cancer survivors 1. Some key points to consider when deciding on the use of estradiol vaginal cream in patients with a history of breast cancer include:
- The level of estrogen absorption can be variable, which raises concerns in patients with a history of breast cancer 1
- Non-hormonal options, such as vaginal moisturizers and lubricants, should be tried first for vaginal symptoms
- Low-dose vaginal estrogen preparations, such as ultra-low dose estradiol vaginal preparations (e.g., Vagifem 10 mcg tablets or Imvexxy 4 mcg inserts), may be safer alternatives to cream formulations 1
- Ospemifene or DHEA vaginal inserts (prasterone) offer non-estrogen approaches to treating vaginal symptoms and may be considered for some patients 1
- Any decision to use hormonal therapy should involve shared decision-making with the patient and coordination between gynecology and oncology providers 1
From the FDA Drug Label
CONTRAINDICATIONS Estradiol valerate injection, USP should not be used in women with any of the following conditions: ... Known, suspected, or history of cancer of the breast.
Who should not take Estradiol valerate injection, USP ? Do not start taking Estradiol valerate injection, USP if you: ... have or had certain cancers. Estrogens may increase the chances of getting certain types of cancers, including cancer of the breast or uterus. If you have or had cancer, talk with your healthcare provider about whether you should take Estradiol valerate injection, USP .
The use of estrogen in a patient with a history of breast cancer is contraindicated, as it may increase the risk of cancer recurrence. Therefore, estradiol vaginal cream is not safe for a patient with a history of breast cancer 2.