Estrogen therapy after breast cancer diagnosis and breast cancer mortality risk

Sund, Maria; Garmo, Hans; Andersson, Anne; Margolin, Sara; Ahlgren, Johan; Valachis, Antonios

doi:10.1007/s10549-023-06871-w

Cited by 9 publications

(5 citation statements)

References 25 publications

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“…A recent Swedish case-control study showed no increase in breast cancer-specific mortality in patients with breast cancer who used estrogen but did not distinguish between vaginal or systemic estrogen. 14 In the absence of trials of vaginal estrogen therapy in breast cancer, the findings of this study provide some reassurance that patients with breast cancer who received vaginal estrogen therapy were not at a markedly higher risk of breast cancer-specific mortality and appear to support national guidelines suggesting that vaginal estrogen therapy can be considered for genitourinary symptoms if nonhormonal treatments are unsuccessful. 3,15 The systemic HRT associations were examined for completeness but should not be a factor in clinical decisions given the wide CIs and previous trial observations of increased risks of recurrence with systemic HRT.…”

Section: Discussionsupporting

confidence: 59%

“…Two small cohort studies found no increase in cancer recurrence in patients with breast cancer who received vaginal estrogen therapy, but both studies included fewer than 10 recurrences in the exposed group. A recent Swedish case-control study showed no increase in breast cancer–specific mortality in patients with breast cancer who used estrogen but did not distinguish between vaginal or systemic estrogen …”

Section: Discussionmentioning

confidence: 99%

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Vaginal Estrogen Therapy Use and Survival in Females With Breast Cancer

McVicker,

Labeit,

Coupland

et al. 2024

JAMA Oncol

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ImportanceGenitourinary syndrome of menopause can be treated with vaginal estrogen therapy. However, there are concerns about the safety of vaginal estrogen therapy in patients with breast cancer.ObjectiveTo determine whether the risk of breast cancer–specific mortality was higher in females with breast cancer who used vaginal estrogen therapy vs females with breast cancer who did not use hormone replacement therapy (HRT).Design, Setting, and ParticipantsThis cohort study analyzed 2 large cohorts, one each in Scotland and Wales, of females aged 40 to 79 years with newly diagnosed breast cancer. These population-based cohorts were identified from national cancer registry records from 2010 to 2017 in Scotland and from 2000 to 2016 in Wales and were followed up for breast cancer–specific mortality until 2020. Females were excluded if they had a previous cancer diagnosis (except nonmelanoma skin cancer). Data analysis was performed between August 2022 and August 2023.ExposureUse of vaginal estrogen therapy, including vaginal tablets and creams, was ascertained from pharmacy dispensing records of the Prescribing Information System for the Scotland cohort and from general practice prescription records for the Wales cohort.Main Outcomes and MeasuresThe primary outcome was time to breast cancer–specific mortality, which was obtained from national mortality records. Time-dependent Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% CIs for breast cancer–specific mortality, comparing vaginal estrogen therapy users with HRT nonusers and adjusting for confounders, including cancer stage and grade.ResultsThe 2 cohorts comprised 49 237 females with breast cancer (between 40 and 79 years of age) and 5795 breast cancer–specific deaths. Five percent of patients with breast cancer used vaginal estrogen therapy after breast cancer diagnosis. In vaginal estrogen therapy users compared with HRT nonusers, there was no evidence of a higher risk of breast cancer–specific mortality in the pooled fully adjusted model (HR, 0.77; 95% CI, 0.63-0.94).Conclusions and RelevanceResults of this study showed no evidence of increased early breast cancer–specific mortality in patients who used vaginal estrogen therapy compared with patients who did not use HRT. This finding may provide some reassurance to prescribing clinicians and support the guidelines suggesting that vaginal estrogen therapy can be considered in patients with breast cancer and genitourinary symptoms.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Vaginal Estrogen Therapy Use and Survival in Females With Breast Cancer

McVicker,

Labeit,

Coupland

et al. 2024

JAMA Oncol

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“…The loss of tumor transcription regulation plays an important role in the biological function of the normal body, while taberrant regulation often leads to the occurrence and development of tumors, and nally it is the estrogen pathway. The estrogen pathway plays a very important role in breast cancer, which has been supported by a large amount of data [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Transcriptomic and proteomic analysis of the mechanisms underlying the role of the CCT3 gene in breast cancer

Wang

et al. 2023

Preprint

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Background Breast cancer has surpassed lung cancer as the most common cancer in the world. Our previous research showed that silencing the expression of the CCT3 gene significantly decreased the proliferation and metastasis of breast cancer cells, but the mechanism is still unclear. In this study, we investigated CCT3 gene and protein expression by transcriptomics and proteomics to explore the mechanism underlying its function. Methods MDA-MB-231 cells were transfected with CCT3-siRNA to knock down the expression of the CCT3 gene. qRT‒PCR was used to measure the efficiency of the suppression. We used RNA-seq and tandem mass tag proteomics analysis to identify differentially expressed genes and proteins, respectively. The possible biological consequences were determined by bioinformatics analysis. Results The mRNA expression of CCT3 decreased by 87.6% in MDA-MB-231 cells transfected with shCCT3 lentivirus. RNA-seq identified 449 differentially expressed genes after transfection with shCCT3, including 240 upregulated genes and 209 downregulated genes, and 61 differentially expressed proteins (33 upregulated and 28 downregulated) were identified by TMT proteomics analysis. GO and KEGG enrichment revealed the biological and molecular functions in CCT3-knockdown cells. Conjoint analysis revealed the expression of several genes and proteins, such as RPUSD4, LUC7L3, HELLS, ARL1, and SPINT2. Conclusions We explored the molecular mechanism by which the proliferation and metastasis of breast cancer cells are promoted after the expression of CCT3 is inhibited through transcriptomics and proteomics, and we initially identified several key genes and proteins. The functional verification of these genes requires further research.

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“…At the first visit, we reviewed previous treatment records. Regarding the classification of breast cancer treatment, we mimicked previous studies [ 22 ] and created the classification.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of Two Laser Treatment Strategies for Breast Cancer Survivors With Genitourinary Syndrome of Menopause

Okui¹,

Okui²,

Kouno³

et al. 2023

Cureus

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Background A typical symptom of patients with genitourinary syndrome of menopause (GSM) is dyspareunia. Dyspareunia has been thought to be caused by vaginal dryness. In recent years, a survey of breast cancer survivors (BCS) with GSM has shown that para-hymen is the most painful. Dyspareunia and superficial vulvar pain (vulvodynia) may be closely linked. A recent study showed that vulvodynia is very common in BCS. Therefore, we believe treatment targeting the vagina and the vulva is necessary for pain in BCS with GSM. We hypothesized that treating both the vagina and the vulva would solve the problem of BCS with GSM. We compared the vaginal erbium SMOOTH mode laser (VEL) and neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser (VEL+Nd:YAG) combination treatment over time. This study explores therapeutic targets for pain in BCS with GSM. Methodology This retrospective, case-control study targeted sexually active BCS who reported GSM with vulvodynia and dyspareunia. After all women enrolled in the VEL treatment group had completed treatment, we treated women enrolled in the VEL+Nd:YAG treatment group. A total of 256 women who received either VEL+Nd:YAG or VEL were enrolled. Propensity score (PS)-matching analysis was used to compare two-year postoperative data retrospectively. The PS-matching results registered 102 patients in the VEL+Nd:YAG group and 102 patients in the VEL group. Symptoms were assessed using the visual analog scale (VAS) for vulvodynia before and after laser treatment for one, three, six, 12, and 24 months after completion. As a preliminary study, the vulvodynia swab test confirmed the causative location of dyspareunia. Moreover, the Female Sexual Function Index (FSFI) and Vaginal Health Index Score (VHIS) were assessed. FSFI and VHIS were treated as supplement research because the conditions were unmet. Results In the vulvodynia swab test, dyspareunia, and para-hymen (especially at 4 o’clock and 9 o’clock), all felt pain, and only a few felt pain in the vagina and labia. FSFI improved significantly in the VEL+Nd:YAG group and persisted for two years. VHIS improved equally in both groups and was not significantly different. After the first laser application, the VEL+Nd:YAG and the VEL groups showed sustained efficacy and safety in vulvodynia. Baseline VAS scores (8.74 ± 0.72 vs. 8.79 ± 0.74; p = 0.564) were similar in both groups. Both groups had a significant (p < 0.001) decrease in the VAS score. The VAS values in the VEL+Nd:YAG group and the VEL group decreased from the pretreatment to 3.79 ± 0.63 (p < 0.001 vs. baseline) and 5.56 ± 0.89 (p < 0.001 vs. baseline) after the third treatments, respectively. After 24 months, the VAS value in the VEL+Nd:YAG group and the VEL group was at 4.43 ± 1.38 (p < 0.001 vs. baseline) and 5.56 ± 0.89 (p < 0.001 vs. baseline), respectively. The side effects in both groups were short-term and minor. Conclusions Both VEL+NdYAG and VEL effectively and safely treat GSM dyspareunia ...

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Estrogen therapy after breast cancer diagnosis and breast cancer mortality risk

Cited by 9 publications

References 25 publications

Vaginal Estrogen Therapy Use and Survival in Females With Breast Cancer

Vaginal Estrogen Therapy Use and Survival in Females With Breast Cancer

Transcriptomic and proteomic analysis of the mechanisms underlying the role of the CCT3 gene in breast cancer

Efficacy of Two Laser Treatment Strategies for Breast Cancer Survivors With Genitourinary Syndrome of Menopause

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