OBJECTIVE To assess the risk of breast cancer recurrence, breast cancer-specific mortality, and overall mortality for breast cancer survivors receiving vaginal estrogen therapy for genitourinary syndrome of menopause. DATA SOURCES From the inception of each database to April 6th, 2024, a systematic literature search was conducted in Google Scholar, PubMed, EMBASE, CINAHL, NCBI, and Science Direct. A secondary search was conducted on September 26th, 2024 utilizing Google Scholar, PubMed, EMBASE, CINAHL, and Science Direct. STUDY ELIGIBILITY CRITERIA We identified studies that reported on breast cancer recurrence defined per individual review criteria and considered both local and distant recurrence. STUDY APPRAISAL AND SYNTHESIS METHODS Three reviewers evaluated studies with eligibility criteria in mind. Breast cancer recurrence was the primary outcome. The secondary outcomes included: breast cancer mortality and overall mortality. Pooled unadjusted odds ratios with 95% confidence intervals were calculated using a random-effects model. We assessed the 95% prediction intervals to calculate the likely range within which we can expect to observe future individual values, based on a current model or data set. We calculated the Fragility Index to evaluate the robustness of the pooled estimates. RESULTS Of 5,522 articles identified, eight observational studies were included in this meta-analysis. The use of vaginal estrogen in patients with a history of breast cancer was not associated with an increased risk of breast cancer recurrence (six articles, 24,060 patients, odds ratio, 0.48; 95% confidence interval, 0.23-0.99). There was no increase in the risk of breast cancer mortality (four articles, 61,695 patients, odds ratio 0.60; 95% confidence interval 0.17-2.02). Lastly, there was no increase in overall mortality with use of vaginal estrogen in breast cancer survivors (five articles 59,724, odds ratio 0.45; 95% confidence interval 0.42-0.49). CONCLUSION The use of vaginal estrogen in patients with a history of breast cancer does not appear to be associated with an increased risk of breast cancer recurrence, breast cancer-specific mortality, or overall mortality.

中文翻译：

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“乳腺癌幸存者阴道雌激素的使用：复发和死亡风险的系统评价和荟萃分析”。


目的 评估接受阴道雌激素治疗绝经期泌尿生殖系统综合征的乳腺癌幸存者乳腺癌复发风险、乳腺癌特异性死亡率和总死亡率。数据来源 从每个数据库成立到 2024 年 4 月 6 日，在 Google Scholar、PubMed、EMBASE、CINAHL、NCBI 和 Science Direct 中进行了系统的文献检索。2024 年 9 月 26 日，利用 Google Scholar、PubMed、EMBASE、CINAHL 和 Science Direct 进行了二次检索。研究合格标准 我们确定了根据个体综述标准定义的乳腺癌复发报告的研究，并考虑了局部和远处复发。研究评价和综合方法 三位评价员在考虑合格标准的情况下评价研究。乳腺癌复发是主要结局。次要结局包括：乳腺癌死亡率和总死亡率。使用随机效应模型计算合并的未调整比值比和 95% 置信区间。我们评估了 95% 的预测区间，以根据当前模型或数据集计算我们可以预期观察到未来个体值的可能范围。我们计算了脆弱性指数来评估合并估计的稳健性。结果 在确定的 5,522 篇文章中，本荟萃分析纳入了 8 项观察性研究。有乳腺癌病史的患者使用阴道雌激素与乳腺癌复发风险增加无关（6 篇文章，24,060 名患者，比值比，0.48;95% 置信区间，0.23-0.99）。乳腺癌死亡风险没有增加（四篇文章，61,695 名患者，比值比 0.60;95% 置信区间 0.17-2.02）。 最后，乳腺癌幸存者使用阴道雌激素后总死亡率没有增加（5 篇文章 59,724，比值比 0.45;95% 置信区间 0.42-0.49）。结论 在有乳腺癌病史的患者中使用阴道雌激素似乎与乳腺癌复发风险、乳腺癌特异性死亡率或总死亡率增加无关。