Navigating vasomotor symptoms in breast cancer patients

In a recent interview, Michelle Jacobson, MD, MHSc, FRCSC menopause specialist at the University of Toronto, discussed her session about managing vasomotor symptoms (VMS) at the 2024 ACOG Annual Clinical & Scientific Meeting.

The session highlighted challenging cases in patients impacts by VMS, primarily focusing on patients impacted by or at high risk of breast cancer. With increasing rates of breast cancer and a current prevalence of approximately 1 in 8 women in Canada, it is vital to discuss menopause symptoms in these patients.

Early-stage breast cancer has a high survival rate, allowing early-stage presenters to reach menopause and face associated concerns. For example, patients utilizing menopause management methods such as hormonal therapy may have to halt these practices because of breast cancer risks.

Menopausal symptoms may be difficult to control when patients are not sure which management options are safest to use. Jacobson hopes that the presentation will help doctors be more comfortable managing symptoms in breast cancer patients.

Hormonal and non-hormonal therapy use will heavily depend on an individual patient’s presentation and risk factors. For example, most women with estrogen-receptor positive disease will be contraindicated from using estrogen therapy, needing to use non-hormonal methods despite osteoporosis and cardiac risks.

New treatment methods have also received approval for use in the United States to manage VMS. This includes fezolinetant, a non-hormonal therapy that impacts the same region of the brain as hormonal therapy to reduce hot flashes. This provides a safer therapy for women with contraindications to hormonal therapy.

In other cases, such as women with a triple negative breast cancer in an early stage, evidence about the best treatment option remains controversial. This indicates a need for research about the impact of hormonal therapy among these populations.

Jacobson hopes that doctors who attend the session will be aware about the different options for managing menopausal symptoms. She also hopes doctors will understand the significant impact symptoms can have on patients’ quality of life, morbidity, and mortality.