TY - JOUR
T1 - Topical estrogen prescribing patterns for urogenital atrophy among women with breast cancer
T2 - Results of a national provider survey
AU - Richter, Lee A.
AU - Han, Jim
AU - Bradley, Sarah
AU - Lynce, Filipa C.
AU - Willey, Shawna C.
AU - Tefera, Eshetu
AU - Pollack, Craig E.
N1 - Funding Information:
Received October 11, 2018; revised and accepted December 13, 2018. From the 1MedStar Washington Hospital Center, Division of Urogyne-cology, Washington, DC; 2Georgetown University School of Medicine, Washington, DC; 3MedStar Georgetown University Hospital, Department of Oncology, Washington, DC; 4MedStar Georgetown University Hospital, Department of Surgery, Washington, DC; 5MedStar Health Research Institute, Washington, DC; and 6Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Funding/support: Financial support for this project was provided by a MedStar New Investigator Grant. Financial disclosure/conflicts of interest: CEP reports stock ownership in Gilead Pharmaceuticals. FCL receives funding from Pfizer. The authors have no other conflict of interest or financial disclosures. Address correspondence to: Lee A. Richter, MD, National Center for Advanced Pelvic Surgery, MedStar Washington Hospital Center, 106 Irving Street NW, POB 405 South, Washington, DC 20010. E-mail: Lee.ann.richter@medstar.net
Publisher Copyright:
© 2019 by The North American Menopause Society.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Objective:The aim of the study was to evaluate knowledge, attitudes, and practice patterns of physicians prescribing topical estrogen for women with urogenital atrophy and a history of breast cancer.Methods:A cross-sectional survey of breast surgeons, urogynecologists, and gynecologists was distributed via their professional societies: the American Society of Breast Surgeons (ASBrS), the American Urogynecologic Society (AUGS), and the Society of Gynecologic Surgeons (SGS). Providers reported level of comfort prescribing vaginal estrogen for urogenital symptoms for women with different categories of breast cancer and current treatment: estrogen receptor (ER) negative, ER positive no longer on endocrine therapy, and ER positive currently on adjuvant endocrine therapy. General knowledge questions assessed agreement on a 5-point Likert scale to statements about vaginal estrogen safety and pharmacology.Results:A total of 820 physicians completed the survey: 437 responses from the ASBrS (response rate, 26.7%), 196 from AUGS (15%), and 187 from SGS (44.5%). The majority of physicians (84%), regardless of specialty, felt comfortable prescribing vaginal estrogen to women with a history of ER-negative cancer: 65.7% felt comfortable prescribing for women with ER-positive breast cancer no longer on endocrine therapy; 51.3% for women on an aromatase inhibitor; and 31.4% for women on tamoxifen. Urogynecologists were significantly more comfortable than breast surgeons prescribing vaginal estrogen for the lowest risk patients, whereas breast surgeons had the highest level of comfort for women currently on endocrine therapy.Conclusions:This study highlights heterogeneity in practice patterns both within and across specialties. The clinical variation seen in this study suggests providers may benefit from increased knowledge regarding vaginal estrogen.
AB - Objective:The aim of the study was to evaluate knowledge, attitudes, and practice patterns of physicians prescribing topical estrogen for women with urogenital atrophy and a history of breast cancer.Methods:A cross-sectional survey of breast surgeons, urogynecologists, and gynecologists was distributed via their professional societies: the American Society of Breast Surgeons (ASBrS), the American Urogynecologic Society (AUGS), and the Society of Gynecologic Surgeons (SGS). Providers reported level of comfort prescribing vaginal estrogen for urogenital symptoms for women with different categories of breast cancer and current treatment: estrogen receptor (ER) negative, ER positive no longer on endocrine therapy, and ER positive currently on adjuvant endocrine therapy. General knowledge questions assessed agreement on a 5-point Likert scale to statements about vaginal estrogen safety and pharmacology.Results:A total of 820 physicians completed the survey: 437 responses from the ASBrS (response rate, 26.7%), 196 from AUGS (15%), and 187 from SGS (44.5%). The majority of physicians (84%), regardless of specialty, felt comfortable prescribing vaginal estrogen to women with a history of ER-negative cancer: 65.7% felt comfortable prescribing for women with ER-positive breast cancer no longer on endocrine therapy; 51.3% for women on an aromatase inhibitor; and 31.4% for women on tamoxifen. Urogynecologists were significantly more comfortable than breast surgeons prescribing vaginal estrogen for the lowest risk patients, whereas breast surgeons had the highest level of comfort for women currently on endocrine therapy.Conclusions:This study highlights heterogeneity in practice patterns both within and across specialties. The clinical variation seen in this study suggests providers may benefit from increased knowledge regarding vaginal estrogen.
KW - Breast cancer
KW - Clinical knowledge
KW - Prescribing pattern
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U2 - 10.1097/GME.0000000000001311
DO - 10.1097/GME.0000000000001311
M3 - Article
C2 - 30939535
AN - SCOPUS:85069236175
SN - 1072-3714
VL - 26
SP - 714
EP - 719
JO - Menopause
JF - Menopause
IS - 7
ER -