Vaginal Estrogen Therapy for Vulvovaginal Atrophy in Women with a Personal History of Breast Cancer – A Claims Database Analysis

Abstract

ABSTRACT Introduction Systemic therapies for breast cancer – selective estrogen receptor modulators (SERM), aromatase inhibitors (AI), oophorectomy, and chemotherapies – often result in vulvovaginal atrophy (VVA or atrophic vaginitis), in up to 70% of postmenopausal breast cancer survivors. While systemic estrogen therapy is often avoided in these patients, vaginal estrogen therapy is a safe treatment option that can be used to treat VVA symptoms in breast cancer survivors. Objective Our objective is to assess the use of vaginal estrogen for women with a diagnosis of VVA and a personal history of breast cancer using a large US claims database. Methods The TriNetX Diamond network database was queried: a US health research network of 190 million patients, encompassing healthcare encounters and prescriptions between 2009-2021. Females with a diagnosis of postmenopausal atrophic vaginitis or atrophy of the vulva (ICD-10 N95.2, N90.5) were included. Of these, women with breast cancer (C50 or Z86.000) were included if the diagnosis was at least 1 month prior to VVA diagnosis. Estrogen receptor status was collected when available (ICD-10 Z17.0, Z17.1). Prescriptions for treatment of VVA were included if prescribed within 1 year of VVA diagnosis. Incidence of vaginal estrogen use in patients with a history of breast cancer was determined for 2013-2015, 2016-2018, and 2019 to present. Results A total of 2,159,766 women with VVA were identified; of whom, 4.8% (n=104,327) had a personal history of breast cancer.Vaginal estrogen prescriptions were less frequent prescribed to women with history of breast cancer compared to women without (11% vs 22%, p<0.01, Table 1). Incidence rate of vaginal estrogen prescriptions for women with VVA and history of breast cancer remained stable around 10-11% from 2013 to present. 25,410 women with VVA and history of breast cancer had positive estrogen receptor status (ER+) and 4,893 had negative estrogen receptor status (ER-). There was no difference in vaginal estrogen prescribing between ER+ and ER- patients (7.4% vs 8.4%). Conclusions While vaginal estrogen can be safely used in women with VVA and personal history of breast cancer, it is prescribed for few eligible patients. Barriers to prescribing and using vaginal estrogen in this population should be explored, in order to significantly improve quality of life for those living with vulvovaginal atrophy. Disclosure No