Indeed, as systemic absorptionis negligible (73) and noimpact on breast cancer-specific mortality has been identified (74), the SfE supports the use ofvaginal estrogen in FH, where breast cancer has been treated with curativeintent and there are sexual or urogenital symptoms; especially in women takingtamoxifen (rather than aromatase inhibitors) or having ER-negative disease(1). This evidence concerns the gene ESR1 and breast cancer.