vaginal estrogen cream and letrozole
i am 60 yo (post menopause) and i had R mastectomy 4 weeks ago due to dcis stage 0 and grade 2. i will start letrozole soon and i had vagina atrophy already and using vaginal estrace a pea size (tiny amount) twice a week and my oncologist is ok for me to continue to use it but i read that estrace will increase the chance to have breast cancer for ER+ even on AI. I still have the left breast which is fine and i need to think of. any advice would be appreciated.
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I’m not sure which source you read but, although true for most people, the fact that your oncologist would allow you to continue counts for something. Was your original prescription from a gynecologist? It might be good to check with that person as a 2nd opinion.
Another approach would be to stop or taper use to just once a week and see if it makes a dramatic difference. However, being on an aromatase inhibitor may also have an impact so take that into account when you decide to change things.
Hope you find a plan that works. Others could be interested in your experience. Come back & share how it goes.
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I had vaginal atrophy AND urethritis due to exemestane. My internist prescribed premarin cream. My MO, who was strictly by the book, said NO WAY. To me, this was a QOL issue and I adamantly made that point to my male MO. I used a smaller-than-pea-sized smear of cream and put it directly on urethra. It took about 5 nightly applications for the urethra to behave. Had to repeat several months later and, then, as needed. No regrets and I'd do it again.
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When my oncologist hits/gets a gynelogy issue, she consults with the oncologist gynecologists at my cancer center, and/or, now she is referring me to the center's sexual health team. If your doctor also takes this kind of humble and multidisciplinary approach, I don't see why not to trust them.
That said, my oncologist's recommendation while I'm waiting to see the sexual health team was to try a vaginal moisturizer. I am trying Revaree, which was on the list she sent me. I did some googling (I am NOT a medical researcher or scientist or doctor, so please take with a grain of salt), but from what I can tell, there is some evidence that sodium hyaluronate (which is the main ingredient in revaree) may be as effective as estrogen creams, at least for some women. It's not cheap, but so far it's helping me a lot.
(I've also had invasive breast cancer twice, which seems like a much higher risk calculation than DCIS)
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i had vaginal atrophy 2 months before i found out i had dcis. i tried many stuff but not for long. i tried hyaluronic acid and it did not work well. my OB wanted me to try replens and i did not want to bc i think i have problem with glycerin. the best worked for me is compound estradiol cream and i used pea size twice a week. then i had dcis and the surgeon told me to stop vaginal estrogen cream due to ER+. then i used good clean love once a day and i am kind of manage. I am afraid if i started letrozole. i need to use compound estradiol cream again. the MO is ok for me to resume the vaginal estradiol cream as before. but i read that vaginal estrogen cream with AI can increase the chance of breast cancer. so i am thinking taking 1/2 letrozole to start with (not start vaginal estrogen cream again). i know the research was done on the 2.5 mg. but i think 1/2 may still work if i do all the heathy stuff like diet, exercise and avoid alcohol and so on. i do not have family history of breast cancer. it is quite a surprise to me. the MO did not order genetic tests for me and i paid for myself to do it and i am waiting for the result. the hormonal therapy seems to me is prevention measure for my L breast which is fine. My R breast had dcis stage 0, grade 2, no evidence of invasion, clean lymph node. i already had R mastectomy. i will try letrozole and continue to work with the MO to do some prevention for L breast. MO did mention that see how i tolerate letrozole and adjust the plan accordingly and he seems to be nice. thanks for all the responses!
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Oncologists used to be against the use of estrogen cream applied locally in breast cancer patients with estrogen positive cancer, but recent studies have confirmed their safety, so they are more likely to prescribe it now. My MO was against it a couple years ago, before the latest studies were published, but now she says she is very comfortable approving a prescription from my gynecologist.
So I think that you can trust your oncologist, seems to be giving updated advice, whereas the noise you have heard against may be the outdated approach, but you can also consult with another oncologist or with a gynecologist-oncologist if you want to have extra peace of mind.
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