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Mammogram Recall Rates After Stopping Hormone Therapy
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What is the problem and what is known about it so far?
Mammograms are special x-rays of the breast that can identify breast cancer before a woman or her doctor can feel a lump. Mammograms are not totally accurate. They sometimes suggest cancer when it is not present (a false-positive result), or look normal even though cancer is present (a false-negative result). Younger women's breasts contain less fat and are denser than older women's breasts. Also, if women take hormones, such as progestin and estrogen, their breasts become less fatty and denser. Mammograms of dense breasts are harder to read than mammograms of fatty breasts. Women with dense breasts may need additional imaging studies to confirm the presence of lesions or cancer. Few studies have assessed ways to reduce the number of “recalls” for additional testing when breasts are dense and mammogram findings are unclear.
Why did the researchers do this particular study?
To see whether stopping hormone therapy for a short period reduces breast density and the frequency of recalls after screening mammograms.
Who was studied?
1704 women between 45 and 80 years of age who used hormone therapy.
How was the study done?
The authors recruited women who were due for a screening mammogram. Before these mammograms, researchers randomly assigned the women to receive no hormone therapy for 1 month, no hormone therapy for 2 months, or continued therapy. The women then had mammograms and answered questions about menopause symptoms. A radiologist who did not know whether the women were taking hormone therapy read the mammograms. If the radiologist thought that additional imaging or evaluation of either breast was necessary, he or she “recalled” the patient. The researchers then compared the number of recalls in the 3 groups.
What did the researchers find?
Stopping hormone therapy decreased breast density by small amounts. Recall rates, however, were similar in women who stopped and continued therapy. Rates with 1 and 2 months of stopping hormone therapy were 12.3% and 9.8%, respectively, and 11.3% with continued hormone therapy. Menopause symptoms increased among groups that stopped hormone therapy.
What were the limitations of the study?
Many women declined participation because they did not want to stop hormone replacement therapy. One radiologist read all mammograms. The researchers did not assess whether recall rates affected the accuracy of diagnosis of any breast lesions or clinical outcomes.
What are the implications of the study?
Stopping hormone therapy for 1 to 2 months did not decrease recall rates in women having screening mammograms.
Article and Author Information
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The summary below is from the full report titled “Short-Term Hormone Therapy Suspension and Mammography Recall. A Randomized Trial.” It is in the 2 June 2009 issue of Annals of Internal Medicine (volume 150, pages 752-765). The authors are D.S.M. Buist, M.L. Anderson, S.D. Reed, E.J. Aiello Bowles, E.D. Fitzgibbons, J.C. Gandara, D. Seger, and K.M. Newton.
