Dense breasts have less fat and more non-fat tissue compared to breasts that aren't dense. Mammograms of dense breasts can be harder to read accurately. Hormone replacement therapy (HRT) can make some women's breasts denser. Doctors sometimes recommend stopping HRT a month or two before a mammogram, hoping that the mammogram can be read more accurately. The study reviewed here found that stopping HRT before a mammogram didn't improve the accuracy of the mammogram reading.
Mammograms are probably the most important tool used to diagnose breast cancer. While safe and generally quite accurate, mammograms aren't perfect. When a mammogram identifies an abnormality that looks like a cancer but turns out to be normal, it's called a false positive. Ultimately the news is good: no breast cancer. But false positives do cause psychological stress, extra tests and procedures, and additional follow-up visits with a doctor.
Getting a false positive result from a mammogram is more likely in women with dense breasts. Since HRT tends to increase breast density, women using HRT are more likely to get a false positive mammogram result.
This study, called the Radiological Evaluation and Breast Density (READ) trial, looked at more than 1,700 women between the ages of 45 and 80 who were taking HRT to ease menopausal symptoms:
The researchers found that the risk of false positive mammogram results were the same for all three groups of women. So stopping HRT before the mammogram didn't improve the accuracy of the mammogram.
The differences in the false positive rates weren't statistically significant, which means they could have been the result of chance and not because of stopping HRT.
The researchers did find that women who stopped taking HRT before getting a mammogram had less dense breasts than women who didn't stop HRT. Still, women who stopped taking HRT tended to have more menopausal symptoms compared to women who kept taking HRT.
If you're taking HRT to ease menopausal symptoms, your doctor may recommend that you stop taking HRT before getting your annual mammogram. If so, you might consider talking about this study with your doctor. Based on these results, stopping HRT may not make your mammogram reading more accurate and you may have more menopausal symptoms.
Taking HRT is one way to deal with menopausal symptoms, but HRT can increase the risk of breast cancer. Visit the Breastcancer.org Managing Menopausal Symptoms section for information on menopausal symptoms and ways to manage them.
LITTLE FALLS, N.J., June 1 (MedPage Today) -- Taking a break from hormone replacement therapy doesn't reduce a woman's chances of having to return for a second screening mammogram, researchers say.
Hormone therapy increases breast density, and abnormal screening mammograms are more common among women with denser breasts, but recall rates were not significantly different between women who didn't take a break from hormone therapy and those who took one or two months off prior to screening, according to Diana S. M. Buist, Ph.D., M.P.H., and colleagues.
"No evidence supports short-term hormone therapy suspension before mammography," they reported in the June 2 issue of the Annals of Internal Medicine.
To prevent false positives and avoid recalls, some women take short breaks from using postmenopausal hormone therapy before having mammography.
However, no evidence exists for the efficacy of this practice.
So to test whether one or two months off the hormones decreases mammography recall rates, the researchers looked at 1,704 women ages 45 to 80 who had used hormone therapy at their most recent screening in the Radiological Evaluation and Breast Density (READ) trial.
All of the women were due for mammography and were still using hormones when they were included in the study.
About a third of the women suspended their hormones for one month, and another third for two months before getting a mammogram. The rest, who continued on their hormone regimen, served as the control group.
The researchers found no significant differences between recall rates among the three groups -- 11.3% in the continuous-hormone group, 12.3% in the one-month suspension group, and 9.8% in the two-month suspension group.
They also found that decreases in percentage of breast density were not statistically significant, although they trended downward -- 0.1% for no suspension, -0.9% for one-month suspension, and -1.5% for two-month suspension.
However, women in the groups who stopped hormone treatment experienced increased menopause symptoms.
The linear trends of increased recall were seen with increasing percentage of density, signaling that "density is still an important factor influencing recall rates, but it is likely that change in density needs to be large to have any clinical effect on recall rates," the researchers said.
"We really hoped to find that a brief break in hormone therapy would lower false-positives and remove unnecessary costs and anxiety by improving mammography," Dr. Buist said. "We were disappointed to find that it didn't, but we'll keep trying to find ways to reduce recall rates for women."
The researchers noted that their study is limited in that it can only be generalized to women ages 45 to 80 who have used hormone therapy for at least one year.
The study was supported by a grant from the National Cancer Institute.
The researchers reported no conflicts of interest.
Primary source: Annals of Internal Medicine Source reference: Buist DSM, et al "Short-term hormone therapy suspension and mammography recall" Ann Intern Med 2009; 150: 752-65.
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