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There is minimal systemic absorption with low-dose formulations, with serum estradiol levels remaining within postmenopausal ranges. Large observational studies and meta-analyses show no increased risk of breast cancer recurrence or mortality among users, including those with estrogen receptor\u2013positive disease and those on tamoxifen. Data on patients receiving aromatase inhibitors (AIs) are more limited. Current evidence supports the safety and efficacy of low-dose vaginal estrogen for GSM in most cancer survivors, with no clear increase in recurrence or mortality. Although nonhormonal therapies should be considered first-line, low-dose vaginal estrogen is an appropriate and effective option for patients with refractory symptoms along with shared decision making and multidisciplinary care. Further prospective studies are needed, especially in patients receiving AIs.<\/jats:p>","DOI":"10.1200\/op-26-00625","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:59:09Z","timestamp":1791230349000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Use of Vaginal Estrogen in Breast and Gynecologic Cancer Survivors"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8664-2423","authenticated-orcid":true,"given":"Jersey B.","family":"Burns","sequence":"first","affiliation":[{"name":"Division of Urogynecology and Reconstructive Pelvic Surgery, Women's and Children's Institute, Cleveland Clinic, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariam M.","family":"AlHilli","sequence":"additional","affiliation":[{"name":"Division of Gynecology, Integrated Surgical Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7476-6664","authenticated-orcid":true,"given":"Azka","family":"Ali","sequence":"additional","affiliation":[{"name":"Division of Breast Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1918-4607","authenticated-orcid":true,"given":"Erin","family":"Roesch","sequence":"additional","affiliation":[{"name":"Division of Breast Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepanjana","family":"Das","sequence":"additional","affiliation":[{"name":"Division of Urogynecology and Reconstructive Pelvic Surgery, Women's and Children's Institute, Cleveland Clinic, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/GME.0000000000000329"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.24140"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/GME.0000000000001752"},{"key":"e_1_3_4_5_2","first-page":"1740","article-title":"Hormone therapy for prevention of chronic conditions","volume":"328","author":"Mangione CM","year":"2022","unstructured":"Mangione CM, Barry MJ, Nicholson WK, et al: Hormone therapy for prevention of chronic conditions. 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