Safety of Topical Estrogen Use in Patients with a History of Breast Cancer

Introduction: Genitourinary syndrome of menopause (GSM) is a very common condition in women with a history of breast cancer, especially those treated with anti-estrogen therapy.It is a health problem that has a major negative impact on the quality of life of patients who suffer from it, affecting their physical, social, sexual, and psychological health.Topical vaginal estrogens are very effective.However, there is controversy regarding their safety in patients with a history of breast cancer.Objectives: To determine the safety of using topical vaginal estrogens for the treatment of GSM in patients with a history of breast cancer.Methodology: A systematic review was conducted using the PubMed/MEDLINE, Cochrane Library, and EMBASE databases as sources of information, including articles published between 2010 and 2025 that evaluated the safety of topical vaginal estrogen use in patients with GSM and a history of breast cancer.Results: The results suggest that the use of topical vaginal estrogens in these patients appears to be associated with transient elevations in serum estrogen levels, with subsequent normalization of these levels, as well as having no significant impact on the breast cancer recurrence rate and appearing to have a slight protective effect on the breast cancer-specific mortality rate.Conclusions: The use of topical vaginal estrogens appears to be a safe option for the treatment of GSM in patients with a history of breast cancer.