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Management of urogenital atrophy in breast cancer patients: a systematic review of available evidence from randomized trials

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Abstract

Symptoms of urogenital atrophy are common in breast cancer survivors. Its optimal management is currently unknown. A systematic review of randomized controlled trials (RCTs) evaluating treatments for urogenital atrophy in breast cancer patients was performed. EMBASE, Ovid Medline and the Cochrane Library were searched from 1946 to November 2014. Outcomes included improvements in both vaginal symptoms (e.g., dryness, pain, dyspareunia and itching) and vaginal hormone response measured by validated scales [e.g., Vaginal Health Index (VHI) and Vaginal Maturation Index (VMI)]. Of 430 unique citations identified, 4 studies (n = 196) met inclusion criteria. Interventions included pH-balanced gel, Replens®, lidocaine, Estring® and Vagifem®. Sample sizes ranged from 7 to 98 patients. Given the heterogeneity of the studies, a narrative synthesis of results was performed. One study of 98 patients suggested that vaginal pH-balanced gel (mean VHI 5.00 ± 0.816, mean VMI 51.18 ± 3.753) was more efficient than placebo (VHI 16.98 ± 3.875, p < 0.001, VMI 47.87 ± 2.728, p < 0.001) at 12 weeks in providing vaginal symptom relief. In patients who used lidocaine, 90 % had reduced dyspareunia compared to saline in a study of 46 patients. Although increased serum estradiol occurred, both Estring® and Vagifem® were shown to improve quality of life and VMI in a study of seven patients. Treatment of urogenital atrophy remains a challenging issue and there is a paucity of RCT evidence addressing this knowledge gap. It is evident that more prospective trials are needed.

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Conflict of interest

We declare no competing interests.

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Authors and Affiliations

  1. Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada

    Sasha Mazzarello, Stephanie Smith & Mark Clemons

  2. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada

    Brian Hutton

  3. Division of Medical Oncology and Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada

    Mohammed F. K. Ibrahim, Carmel Jacobs, Terry Ng & Mark Clemons

  4. The Ottawa Hospital, Ottawa, Canada

    Risa Shorr

Authors
  1. Sasha Mazzarello
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  2. Brian Hutton
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  3. Mohammed F. K. Ibrahim
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  4. Carmel Jacobs
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  5. Risa Shorr
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  6. Stephanie Smith
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  7. Terry Ng
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  8. Mark Clemons
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Correspondence to Mark Clemons.

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Mazzarello, S., Hutton, B., Ibrahim, M.F.K. et al. Management of urogenital atrophy in breast cancer patients: a systematic review of available evidence from randomized trials. Breast Cancer Res Treat 152, 1–8 (2015). https://doi.org/10.1007/s10549-015-3434-z

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  • DOI: https://doi.org/10.1007/s10549-015-3434-z

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