From the Guidelines
Estradiol vaginal cream can be considered safe in patients with a history of breast cancer, as a large cohort study of almost 50,000 patients with breast cancer found no evidence of a higher risk of breast cancer–specific mortality in those using vaginal estrogen 1. When considering the use of estradiol vaginal cream in patients with a history of breast cancer, it is essential to weigh the benefits against the potential risks. The benefits of vaginal estrogen include effective treatment of vaginal dryness, itching, discomfort, and painful intercourse in postmenopausal individuals, as well as improvement in vaginal atrophy and sexual function 1. Some key points to consider when prescribing estradiol vaginal cream to patients with a history of breast cancer include:
- The use of the lowest effective dose to minimize systemic absorption
- Preference for products with minimal systemic absorption, such as vaginal rings or tablets, rather than creams
- Careful consideration of the patient's individual risk factors, including the type of breast cancer and hormone receptor status
- Shared decision-making with the patient, involving thorough discussion of the risks and benefits
- Regular monitoring for any signs of breast cancer recurrence or worsening symptoms It is also important to note that non-hormonal options, such as vaginal moisturizers and lubricants, should be tried first, and that other treatments, such as ospemifene or vaginal DHEA, may be considered in select cases 1. Ultimately, the decision to use estradiol vaginal cream in patients with a history of breast cancer should be made on a case-by-case basis, taking into account the individual patient's needs and risk factors, and with careful consideration of the potential benefits and risks.
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 .
Estradiol vaginal cream is not mentioned in the provided drug labels, but based on the information about estradiol, estrogen therapy is contraindicated in patients with a history of breast cancer. Therefore, it is likely that estradiol vaginal cream is not safe in a patient with a history of breast cancer. 2 2