{"id":520,"date":"2020-10-10T21:39:40","date_gmt":"2020-10-10T19:39:40","guid":{"rendered":"http:\/\/www.looketmedecine.com\/?p=520"},"modified":"2024-10-04T23:49:35","modified_gmt":"2024-10-04T21:49:35","slug":"subjects-still-taboo-vaginal-health-in-survivors-of-breast-cancer","status":"publish","type":"post","link":"https:\/\/looketmedecine.fr\/en\/subjects-still-taboo-vaginal-health-in-survivors-of-breast-cancer\/","title":{"rendered":"LM N\u00b01\/ 2020. Subjects still taboo: Vaginal Health in Survivors of Breast Cancer. Dana SAWAN MD, Barbara HERSANT MD, PhD."},"content":{"rendered":"

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SUBJECTS STILL TABOO<\/strong><\/span><\/h1>\n

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Vaginal Health of Breast Cancer Survivors.<\/strong><\/span><\/h1>\n

Dana Sawan MD2<\/sup>., Barbara Hersant MD, PhD1,2<\/sup>.<\/strong><\/span><\/h2>\n

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1 Henri Mondor Breast Center, Henri Mondor University Hospitals, 51 Avenue Marechal de Lattre de Tassigny, 94010 Cr\u00e9teil, France.<\/em><\/span><\/h2>\n

2 Department of Maxillo-facial Surgery, Plastic and Reconstructive, Henri Mondor University Hospitals, 51 Avenue Marechal de Lattre de Tassigny, 94010 Cr\u00e9teil, France.<\/em><\/span><\/h2>\n

Dana Sawan: <\/em>dana.s.sawan@gmail.com<\/em><\/a><\/span><\/h2>\n

Barbara Hersant: <\/em>Barbara.hersant@gmail.com<\/em><\/a><\/span><\/h2>\n

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Abstract<\/strong><\/span><\/h2>\n

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Most breast cancers are hormone-sensitive or hormone-dependent on estrogen.<\/h2>\n

The therapeutic strategy is therefore to wean the body from its oestrogen supply, which induces an early menopause in patients who are often still young and genitally active.<\/h2>\n

The menopause is accompanied by a series of general and local manifestations.<\/h2>\n

These can be summed up in the urogenital sphere as a so-called genitourinary menopause syndrome (vaginal dryness, atrophy, dyspareunia, dysuria, etc.).<\/h2>\n

The treatment of this syndrome gives the main role to oestrogens. However, oestrogen carries a risk of recurrence in patients with a history of breast cancer.<\/h2>\n

It is therefore imperative to find alternatives to hormonal treatment. This work aims to do away with these means.<\/h2>\n

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Keywords<\/strong>:<\/span> genito-urinary menopausal syndrome – breast cancer – hormone therapy – alternatives – sex life.<\/h2>\n

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Introduction<\/strong><\/span><\/h2>\n

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Breast cancer is the most common cancer and the leading cause of cancer death in women. The \u00be of breast cancers express estrogen receptors, including Estrogen Receptor alpha (ER\u03b1)1-4<\/sup>.<\/h2>\n

Tumours that do not express oestrogen receptors often express epidermal growth factor receptor (EGFR).<\/h2>\n

The latter has been correlated with larger tumours and metastatic forms5<\/sup>.<\/h2>\n

The hormone sensitivity and hormone dependence of breast cancers makes hormone therapy one of the main means of treating these cancers.<\/h2>\n

It consists of weaning them from the oestrogenic intake that maintains their growth, either by suppressing endogenous production (chemotherapy or irradiation of the ovaries), or by administering an anti-estrogenic substance systemically.<\/h2>\n

Advances in breast cancer detection technology now make it possible to detect tumours at an earlier stage than before and, as adjuvant chemotherapy is associated with ovarian failure,6<\/sup> an increasing proportion of breast cancer survivors are becoming postmenopausal at an earlier age after cancer treatment7<\/sup>. In addition, estrogen levels gradually decline as menopause approaches, leading to genital and urinary symptoms in affected women8<\/sup>.<\/h2>\n

Hormone replacement therapy (HRT) is known to be effective and recommended in the control of menopausal symptoms such as hot flashes, sleep disorders, sexual dysfunction or vaginal atrophy and even the prevention of osteoporosis and cardiovascular disease9,10<\/sup>.<\/h2>\n

In general, systemic estrogen therapy is recommended for women with general symptoms, while local estrogen therapy is recommended for those suffering from Vulvo-Vaginal Atrophy (VVA) or Genito-Urinary Menopausal Syndrome (GUMS)11<\/sup>.<\/h2>\n

However, HRT is risky in breast cancer survivors. Indeed, it has been shown that current and former HRT users have a higher risk of developing breast cancer because estrogen plays a central role in the development of breast cancer12<\/sup>. Thus, women who have received primary treatment for early breast cancer may have a recurrence of the disease after HRT13<\/sup>.<\/h2>\n

Clinicians must therefore consider the goals of systemic endocrine therapy and the safety of this treatment modality in healthy women and those with a history of breast cancer11<\/sup>.<\/h2>\n

Given the safety concerns regarding the use of HRT in women with a history of breast cancer, this document examines alternatives to estrogen replacement therapy that may help address specific survivorship issues such as GUMS in this group of women.<\/h2>\n

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Alternatives to Hormone Replacement Treatment<\/strong><\/span><\/h1>\n

Several alternatives to the use of hormone replacement therapy have been proposed for women with a previous diagnosis of breast cancer.<\/h2>\n

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1.Medical means<\/strong><\/span><\/h1>\n

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1.1. Platelet-rich autologous plasma and hyaluronic acid (Cellular Matrix<\/strong>)<\/span><\/h2>\n

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A multicentre, randomised, controlled, open-label study of 144 women found that hyaluronic acid vaginal gel was effective in improving vaginal dryness in postmenopausal women14<\/sup>.<\/h2>\n

A recent phase 2 clinical study suggested that intraperitoneal administration of a combination of autologous platelet-rich plasma and hyaluronic acid appeared to improve GUMS in women with a previous diagnosis of breast cancer15<\/sup>.<\/h2>\n

Researchers reported a significant increase in the volume of vaginal secretions after the start of treatment.<\/h2>\n

The quality of sexual life of the participants was also significantly improved, as evidenced by a decrease in the female sexual distress score one, three and six months after treatment with platelet-rich autologous plasma and hyaluronic acid15<\/sup>.<\/h2>\n

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CellularMatrix\u00ae <\/strong>INTIMACY <\/strong><\/span><\/h4>\n

The Patient\u2019s Platelet Rich Plasma combined with Hyaluronic Acid for Skin and Mucosa Regeneration.<\/h4>\n

TREATMENT OF GENITOURINARY SYNDROME OF MENOPAUSE (GSM)\u00a0<\/strong><\/span><\/h4>\n