{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T12:54:15Z","timestamp":1793019255217,"version":"4.5.0"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2024,1,1]]},"abstract":"<jats:sec id=\"ab-cbr230017-4\"><jats:title>Importance<\/jats:title><jats:p>Genitourinary 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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-cbr230017-5\"><jats:title>Objective<\/jats:title><jats:p>To determine whether the risk of breast cancer\u2013specific 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).<\/jats:p><\/jats:sec><jats:sec id=\"ab-cbr230017-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This 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\u2013specific 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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-cbr230017-7\"><jats:title>Exposure<\/jats:title><jats:p>Use 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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-cbr230017-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was time to breast cancer\u2013specific 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\u2013specific mortality, comparing vaginal estrogen therapy users with HRT nonusers and adjusting for confounders, including cancer stage and grade.<\/jats:p><\/jats:sec><jats:sec id=\"ab-cbr230017-9\"><jats:title>Results<\/jats:title><jats:p>The 2 cohorts comprised 49\u202f237 females with breast cancer (between 40 and 79 years of age) and 5795 breast cancer\u2013specific 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\u2013specific mortality in the pooled fully adjusted model (HR, 0.77; 95% CI, 0.63-0.94).<\/jats:p><\/jats:sec><jats:sec id=\"ab-cbr230017-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>Results of this study showed no evidence of increased early breast cancer\u2013specific 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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoncol.2023.4508","type":"journal-article","created":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T15:33:17Z","timestamp":1698939197000},"page":"103","source":"Crossref","is-referenced-by-count":101,"title":["Vaginal Estrogen Therapy Use and Survival in Females With Breast Cancer"],"prefix":"10.1001","volume":"10","author":[{"given":"Lauren","family":"McVicker","sequence":"first","affiliation":[{"name":"Centre for Public Health, Queen\u2019s University Belfast, Belfast, Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander M.","family":"Labeit","sequence":"additional","affiliation":[{"name":"Centre for Public Health, Queen\u2019s University Belfast, Belfast, Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol A. C.","family":"Coupland","sequence":"additional","affiliation":[{"name":"Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom"},{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bl\u00e1naid","family":"Hicks","sequence":"additional","affiliation":[{"name":"Centre for Public Health, Queen\u2019s University Belfast, Belfast, Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmel","family":"Hughes","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Queen\u2019s University Belfast, Belfast, Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00dana","family":"McMenamin","sequence":"additional","affiliation":[{"name":"Centre for Public Health, Queen\u2019s University Belfast, Belfast, Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart A.","family":"McIntosh","sequence":"additional","affiliation":[{"name":"The Patrick G. Johnston Centre for Cancer Research, Queen\u2019s University Belfast, Belfast, Northern Ireland"},{"name":"Breast Surgery Department, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Murchie","sequence":"additional","affiliation":[{"name":"Division of Applied Health Sciences Section, Academic Primary Care, University of Aberdeen, Aberdeen, Scotland, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris R.","family":"Cardwell","sequence":"additional","affiliation":[{"name":"Centre for Public Health, Queen\u2019s University Belfast, Belfast, Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"2","key":"cbr230017r1","doi-asserted-by":"publisher","first-page":"109","DOI":"10.3109\/13697137.2015.1129166","article-title":"2016 IMS recommendations on women\u2019s midlife health and 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