Association of New-Onset Breast Discomfort With an Increase in Mammographic Density During Hormone Therapy

Abstract

In postmenopausal women randomly assigned to menopausal hormone therapy vs placebo, new-onset breast discomfort is associated with increased mammographic density.

Gynecologic Safety of Conjugated Estrogens Plus Bazedoxifene: Pooled Analysis of Five Phase 3 Trials

“…45,46 Breast pain/tenderness may be more than just ''nuisance side effects'': New-onset breast tenderness is associated with increased mammographic breast density, 45,47 and breast tenderness and breast density are risk factors for the development of breast cancer. 46,48,49 Increased breast density can also hinder mammographic detection of breast abnormalities.…”

Parallel assessment of the impact of different hormone replacement therapies on breast density by radiologist- and computer-based analyses of mammograms

“…These observations are in line with numerous earlier studies showing similar significant increases in breast density with treatment with continuously combined estrogen plus progestin [18][19][20][21][22][23][24] . Increases in breast density cannot be related to one particular combination or progestin per se, because similar observations were reported from trials testing combinations with norethisterone acetate, medroxyprogesterone acetate or micronized progestin 18,23,25 . Since the effects of estradiol per se are minimal and rarely occur in patients 19 , these observations point to the etiopathogenic role of continuous progestin exposure of breast tissue.…”

“…Recent clinical studies indicate that breast discomfort and breast density are closely related entities 25,28 . The advantage of nasal estradiol may rest in its markedly different pharmacokinetics 29 .…”

“…In summary, nasal estradiol cyclically combined with micronized progesterone appears to offer a gynecologically safer therapeutical choice for hormone replacement therapy; the advantages include less frequent withdrawal or breakthrough bleeding, less frequent mastalgia, and an apparently negligible effect on breast density 30 . These advantages may not only improve long-term compliance to therapy but may also culminate in less concerns for breast cancer, given the fact that increased breast density is often considered a surrogate measure of breast cancer risk in epidemiological studies 25 .…”

Qualitative cross-cultural exploration of breast symptoms and impacts associated with hormonal treatments for menopausal symptoms to inform the development of new patient-reported measurement tools

“…Breast tenderness is reported to occur significantly more frequently in women receiving combined EPT compared with placebo or conjunctive estrogens alone [2] and is associated with increased mammographic breast density [3] and subsequent breast cancer risk [2]. In randomized clinical trials, incidence of breast tenderness in postmenopausal women after initiation of EPT has been reported to range from approximately 9% to 16% [1,2,[4][5][6]. Many women who experience breast tenderness discontinue treatment, potentially due to concerns or fears of breast cancer [7] following publication of such risk in findings from the Women's Health Initiative trials [8].…”