Addressing sexual health issues of breast cancer patients on endocrine therapy

Breast cancer treatments that can save a woman's life can seriously harm her sexual health, says Dr. Kristin E. Rojas, a breast cancer surgeon at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine. Although doctors have not historically been prepared to help patients manage these toxic side effects, Rojas is leading efforts to turn the tide.

Rojas, both a fellowship-trained breast surgical oncologist and a gynecologic surgeon, is a national leader in treating sexual dysfunction in female patients undergoing cancer treatment. Other, more broadly recognized side effects of lifesaving estrogen-blocking medications – also known as endocrine therapy – include challenges with pregnancy planning for premenopausal patients and reduced bone mineralization. According to Rojas, all three of these subjects should be addressed as early as possible when planning a course of therapy for a breast cancer patient with an estrogen-sensitive tumor.

Rojas will identify risks posed by endocrine therapies, define symptoms and discuss treatment options in a presentation at the 2023 ASCO Annual Meeting in Chicago.

"By using endocrine therapy to treat hormone-positive breast cancers, we're putting many young women into menopause, but we're not doing a great job preparing them for it," said Rojas, who created a program to address women's sexual health after cancer treatment, the Menopause Urogenital Sexual Health and Intimacy Clinic (MUSIC) at Sylvester. Faced with unexpectedly high demand, the clinic needed to expand soon after opening in 2020. Since Rojas expanded the program by training additional experts to accommodate this great need, the MUSIC program has become a prototype for similar programs across the country. It remains the only women's oncology-focused sexual health program led by a dual-trained surgeon in the United States.

Patients are often hesitant to bring up sexual health issues with their providers, and that's why we created this groundbreaking program where patients can openly discuss these issues in a one-on-one survivorship program. If we don't address these common concerns experienced by more than 80% of female survivors of cancer, patient adherence to endocrine treatment decreases, and the progress we have made in improving breast cancer survival is impeded."

Kristin E. Rojas, breast cancer surgeon at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine

Rojas' ASCO presentation will help providers anticipate and treat the most common side effects experienced by patients on endocrine therapy (or estrogen-blocking medications), formulate a personalized treatment plan, guide patients toward evidence-based practices and away from potentially harmful "fringe" therapies, and troubleshoot common pitfalls encountered in the treatment of menopausal symptoms.

Among specific topics:

• Hot flashes – causes, triggers and treatments.
• Vaginal dryness and painful sex – causes, irritants, and changes to the vaginal microbiome.
• Genitourinary syndrome of menopause (GSM) – causes, treatments, lubricants, devices and medication options.
• Products, "therapies" and devices to avoid.
• Infertility risk and options for fertility preservation.
• Reduced bone mineralization and increased fracture risk – monitoring and prevention strategies.

Rojas' presentation is part of a session she will chair: "A Juggling Act: Managing the Toxicity of Estrogen Deprivation for Patients With Breast Cancer," Education Session E451. It will begin at 8 a.m. June 5, 2023 (CDT), part of the annual meeting of the American Society of Clinical Oncology.