With the continuous improvement in the level of comprehensive breast cancer treatment, the survival period of postoperative breast cancer patients is getting longer and longer. At present, in addition to the three major treatment measures for breast cancer, such as surgery, radiotherapy and chemotherapy, for premenopausal breast cancer patients with positive hormone receptors (about 60% or more), adjuvant endocrine therapy – i.e., the application of triamcinolone acetonide for 5 years – is still the “gold standard” recommended by breast cancer treatment guidelines “The literature proves that triamcinolone acetonide is the gold standard of breast cancer treatment. The literature demonstrates that triamcinolone acetonide reduces the incidence of recurrent breast cancer metastasis, inhibits the development of contralateral breast cancer, and reduces the risk of death from breast cancer. Recent studies have shown that 10 years of triamcinolone acetonide application is more protective in the breast cancer population. This implies that long-term application of triamcinolone appears to be an optimal option. However, there is a claim that long-term triamcinolone acetonide application substantially increases the risk of endometrial cancer, something that is of great concern to many patients using triamcinolone acetonide. Why: Triamcinolone “promotes” endometrial cancer Triamcinolone is a non-steroidal anti-estrogenic drug that is a derivative of triptans and has been widely used since the 1980s for the adjuvant treatment of breast cancer. Triamcinolone acts as an estrogen receptor antagonist in breast tissues and as an estrogen receptor agonist in endometrial tissues. Elevated estrogen levels lead to endometrial epithelial cell growth, which increases the risk of endometrial carcinogenesis. A series of retrospective studies in the late last century found that the application of triptans in breast cancer patients increased the relative risk of endometrial cancer by more than twofold. Most studies also found that the risk of endometrial cancer did not disappear with discontinuation of the drug. That is, the effect will last longer, but is not related to the dose used. So, is triamcinolone acetonide the culprit of endometrial cancer? In fact, cancer development is a multifactorial, multi-step complex biological process, and endometrial cancer is no exception. Studies have shown that in addition to the risk of endometrial cancer associated with the application of triamcinolone, several other factors increase this risk level, such as obesity, previous estrogen replacement therapy and a history of diabetes. It has been suggested that this increased risk level is more prominent in postmenopausal women, mainly due to the lower concentration of estradiol around postmenopausal women, an environment in which triamcinolone makes the positive estrogenic effect more prominent. However, this claim is controversial. Therefore, we cannot directly equate endometrial cancer with the application of triamcinolone acetonide. Timely Monitoring: Preventing “Endometrial Cancer” Since triamcinolone acetonide does cause endometrial hyperplasia, which increases the risk of endometrial cancer, is there any way to prevent this risk? Unfortunately, there are no very reliable medications to prevent endometrial cancer while using triamcinolone acetonide. Although basic research has confirmed that the addition of moderate amounts of progestin can reduce the occurrence of endometrial hyperplasia, large-scale clinical studies have not confirmed this conclusion, but rather increase the risk of vaginal bleeding, which is not currently promoted clinically. However, since triamcinolone acetonide reduces the incidence of recurrent metastases and reduces the risk of death from breast cancer. Therefore, the risk of endometrial cancer should not be a reason to refuse the use of triamcinolone acetonide in breast cancer patients. Here, we propose the following precautions in the hope that breast cancer patients can apply triamcinolone scientifically and maintain their health. 1. Be alert to painless vaginal bleeding. The early symptoms of endometrial cancer are mainly bleeding, vaginal discharge, lower abdominal pain and abdominal mass. Among them, irregular vaginal bleeding is the main symptom of endometrial cancer, which is often a small to moderate amount of bleeding. Among those who receive endocrine therapy after breast cancer surgery, painless vaginal bleeding should be taken seriously, especially if it occurs in postmenopausal people, and a comprehensive gynecological ultrasound should be performed immediately, and if necessary, an endometrial biopsy should be performed to rule it out. 2. Gynecologic ultrasound monitoring once a year. Gynecologic ultrasound can understand endometrial thickness, uterine size and pelvic condition, and is non-invasive and economical. Therefore, patients on triamcinolone should undergo gynecologic ultrasound once a year. In addition, endometrial biopsy should be performed in patients with endometrial thickness over 5-8 mm and combined with vaginal bleeding; endometrial biopsy should also be performed in patients with abnormal vaginal drainage. In general, about 40% of patients using triamcinolone acetonide have an endometrial thickness >5 mm. 3.Practice good lifestyle habits. Factors such as obesity, hypertension and diabetes can increase the risk of endometrial cancer. Therefore, reasonable diet and moderate exercise and maintaining a healthy mind can also reduce the risk of endometrial cancer. In conclusion, triamcinolone acetonide remains indestructible as the “cornerstone” of postoperative adjuvant therapy for hormone receptor-positive breast cancer, and its benefits for breast cancer patients far outweigh its possible risk of endometrial cancer. Therefore, patients should not say “No” to triamcinolone because of fear, as long as triamcinolone is applied scientifically, they can stay away from the recurrence of breast cancer and live a more worry-free life after surgery. New breast cancer endocrine therapy drugs have significant advantages over triamcinolone acetonide! In recent years, a new type of breast cancer endocrine therapy drug, aromatase inhibitor, has been introduced to bring blessings to breast cancer patients. Studies have confirmed that in the postmenopausal population, aromatase inhibitors reduce more metastatic recurrence events of breast cancer and reduce the risk of endometrial hyperplasia. Therefore, aromatase inhibitors may also be used in the postmenopausal population under the guidance of a physician to reduce the risk of endometrial carcinogenesis.