Gynecologic Problems in Patients with Breast Cancer

Abstract

Many patients with breast cancer experience gynecologic problems during or after breast cancer treatment. Some of these problems are caused by chemotherapy or hormonal therapy; others are caused by low estrogen levels; and still others are unrelated to breast cancer or its treatment. Women who receive myelosuppressive chemotherapy are more likely to suffer vulvar and vaginal infections, as the chemotherapy can affect ovarian function and thus alter the vaginal ecosystem. Dyspareunia in patients with breast cancer may be due to loss of secretion of the secondary sexual glands, spasm of muscles around the vagina, or aggravation of psychosexual problems that existed before the breast cancer diagnosis. Patients taking tamoxifen are at increased risk for endometrial carcinoma and require careful monitoring. Low estrogen levels can exacerbate urinary incontinence. The evaluation of abnormal vaginal bleeding, uterine or vaginal prolapse, and uterine or ovarian enlargement in breast cancer patients is similar to the evaluation of these problems in patients without breast cancer. Vaginal sonography and hysteroscopy are useful diagnostic tools in patients with vaginal bleeding or other pelvic symptoms. More and more women are asking gynecologists about prophylactic oophorectomy. This surgery may be appropriate in women with a genetic predisposition to ovarian cancer.