Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: consensus recommendations from The North American Menopause Society and The International Society for the Study of Women's Sexual Health
Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: consensus recommendations from The North American Menopause Society and The International Society for the Study of Women's Sexual Health
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DOI：
10.1097/gme.0000000000001121
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发表时间：
2018-06-01
影响因子：
2.7
通讯作者：
Kingsberg, Sheryl A.
中科院分区：
文献类型：
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作者：
Faubion, Stephanie S.;Larkin, Lisa C.;Kingsberg, Sheryl A.
北美更年期协会(NAMS)和国际妇女性健康研究协会(ISSWSH)专家共识小组的目标是创建一种治疗患有乳腺癌或乳腺癌高危女性的绝经生殖道综合征(GSM)的护理点算法。协商一致的建议将帮助医疗保健提供者管理GSM，目标是改善这些妇女的护理和生活质量。专家协商一致小组由16名在各自领域备受尊敬的多学科专家组成。小组成员分别对各自专业领域的文献进行了循证审查。然后，他们会面讨论乳腺癌幸存者的绝经生殖道综合征(GSM)的最新治疗选择，并使用改进的德尔菲法审查患有乳腺癌或乳腺癌高危女性的GSM的管理策略。这一迭代过程包括总结当前文献、辩论和讨论关于GSM评估和管理的不同意见，从而为临床制定一致的建议。更年期泌尿生殖系统综合征在乳腺癌幸存者中更常见，通常未被诊断和治疗，并且可能由于癌症治疗或降低风险的策略而早发。在患有或处于乳腺癌高危状态的女性中，缺乏关于阴道激素治疗安全性的证据，这导致了避免治疗，潜在地对生活质量和亲密关系产生了不利影响。影响GSM治疗决策的因素包括乳腺癌复发风险、症状严重程度、对先前治疗的反应和个人偏好。我们回顾了目前有乳腺癌病史或乳腺癌高危女性采用各种药物和非药物治疗方法的证据，强调了安全有效治疗证据的巨大差距和未来研究的必要性。GSM的治疗是个体化的，非激素治疗通常是这一人群的一线治疗。对于一些女性来说，使用局部激素疗法可能是一种选择，这些女性在讨论了风险和益处并与女性肿瘤学家进行了审查后，未能通过非药物和非激素治疗。我们为特定患者群体的GSM管理提供了共识建议，包括乳腺癌高危女性、雌激素受体阳性乳腺癌女性、三阴性乳腺癌女性和转移性疾病女性。
The objective of The North American Menopause Society (NAMS) and The International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel was to create a point of care algorithm for treating genitourinary syndrome of menopause (GSM) in women with or at high risk for breast cancer. The consensus recommendations will assist healthcare providers in managing GSM with a goal of improving the care and quality of life for these women. The Expert Consensus Panel is comprised of a diverse group of 16 multidisciplinary experts well respected in their fields. The panelists individually conducted an evidence-based review of the literature in their respective areas of expertise. They then met to discuss the latest treatment options for genitourinary syndrome of menopause (GSM) in survivors of breast cancer and review management strategies for GSM in women with or at high risk for breast cancer, using a modified Delphi method. This iterative process involved presentations summarizing the current literature, debate, and discussion of divergent opinions concerning GSM assessment and management, leading to the development of consensus recommendations for the clinician.Genitourinary syndrome of menopause is more prevalent in survivors of breast cancer, is commonly undiagnosed and untreated, and may have early onset because of cancer treatments or risk-reducing strategies. The paucity of evidence regarding the safety of vaginal hormone therapies in women with or at high risk for breast cancer has resulted in avoidance of treatment, potentially adversely affecting quality of life and intimate relationships. Factors influencing decision-making regarding treatment for GSM include breast cancer recurrence risk, severity of symptoms, response to prior therapies, and personal preference.We review current evidence for various pharmacologic and nonpharmacologic therapeutic modalities in women with a history of or at high risk for breast cancer and highlight the substantial gaps in the evidence for safe and effective therapies and the need for future research. Treatment of GSM is individualized, with nonhormone treatments generally being first line in this population. The use of local hormone therapies may be an option for some women who fail nonpharmacologic and nonhormone treatments after a discussion of risks and benefits and review with a woman's oncologist. We provide consensus recommendations for an approach to the management of GSM in specific patient populations, including women at high risk for breast cancer, women with estrogen-receptor positive breast cancers, women with triple-negative breast cancers, and women with metastatic disease.