Richter LA, et al. - In order to assess knowledge, attitudes, and practice patterns of physicians prescribing topical estrogen for women with urogenital atrophy and a history of breast cancer, the American Society of Breast Surgeons (ASBrS), the American Urogynecologic Society (AUGS), and the Society of Gynecologic Surgeons (SGS) distributed a cross-sectional survey of breast surgeons, urogynecologists, and gynecologists. The survey was completed by a total of 820 physicians: 437 responses from the ASBrS (response rate, 26.7%), 196 from AUGS (15%), and 187 from SGS (44.5%). Analysis revealed that prescription of vaginal estrogen to women with a history of ER-negative cancer is comfortably made by the majority of physicians (84%), regardless of specialty: 65.7% felt comfortable prescribing for women with ER-positive breast cancer no longer on endocrine therapy; 51.3% for women on an aromatase inhibitor; and 31.4% for women on tamoxifen. Relative to breast surgeons, urogynecologists were significantly more comfortable in prescribing vaginal estrogen for the lowest risk patients, whereas for women currently on endocrine therapy, breast surgeons had the highest level of comfort. Outcomes thereby suggest that practice patterns are heterogeneous in both within and across specialties and increased knowledge regarding vaginal estrogen may benefit the providers.