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In a paper recently published in Annals of Internal Medicine, Buist and colleagues [1] reported the results of a randomized, controlled trial to test whether 1 or 2 months’ suspension of hormone replacement therapy (HRT) before screening mammography would decrease additional mammographic imaging recalls in women aged 45–80 years.

A total of 1704 women aged 45–80 years who used HRT at their most recent index mammography and who were due for a screening mammography and still using hormone therapy were recruited. Block random assignment was carried out by breast density and hormone therapy type to no suspension of hormone therapy or to suspension for 1 or 2 months before mammography. One blinded expert radiologist interpreted all mammograms. The primary endpoint was mammography recall and the secondary endpoint was change in mammographic breast density (percentage and dense area) between the index and study mammograms.

The rate of mammography recall was 11.3% in the no-suspension group, 12.3% in the 1-month suspension group and 9.8% in the 2-month suspension group. No subgroups were identified in which brief suspension of hormone therapy resulted in decreased mammography recall. With suspension of HRT, decreases in the percentage of breast density were orderly and statistically significant: 0.1% for the no-suspension group, -0.9% for the 1-month suspension group and -1.5% for the 2-month suspension group. Similar ordered decreases were observed for dense area. Return of menopausal symptoms was increased in those women who had suspended HRT. Interestingly, 61% of women approached for recruitment into this trial declined because they were concerned about recurrence of menopausal symptoms.

The authors concluded that brief hormone therapy suspension was associated with small changes in breast density but did not affect recall rates and that short-term suspension of HRT before mammography was not justified.

Author(s)

  • Rodney J. Baber
    Associate Professor of Obstetrics and Gynaecology at The University of Sydney, Head, Menopause Unit, The Royal North Shore Hospital of Sydney, New South Wales, Australia

Citations

  1. Buist D, Anderson ML, Reed SD, et al. Short-term hormone therapy suspension and mammography recall: a randomized trial. Ann Intern Med 2009;150:752-65. Published June 2, 2009.
    http://www.ncbi.nlm.nih.gov/pubmed/19487710
  2. Chlebowski RT, Hendrix SL, Langer RD, et al. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Womens Health Initiative randomized trial. JAMA 2003;289:3243-53.
    http://www.ncbi.nlm.nih.gov/pubmed/12824205
  3. Harvey JA, Pinkerton JV, Herman CR. Short-term cessation of hormone replacement therapy and improvement of mammographic specificity. J Natl Cancer Inst 1997;89:1623-5.
    http://www.ncbi.nlm.nih.gov/pubmed/9362162
  4. Speroff L. The impact of the Womens Health Initiative on clinical practice. J Soc Gynecol Invest 2002;9:251-3.
    http://www.ncbi.nlm.nih.gov/pubmed/12383908
  5. Burnside ES, Trentham-Dietz A, Kelcz F, Collins J. An example of breast cancer regression on imaging. Radiol Case Rep 2006;1:27-37.
    http://radiology.casereports.net/index.php/rcr/article/viewArticle/4/183
  6. Weaver K, Kataoka M, Murray J, et al. Does a short cessation of HRT decrease mammographic density? Maturitas 2008;59:315-22.
    http://www.ncbi.nlm.nih.gov/pubmed/18448281
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