Mammographic changes associated with postmenopausal hormone replacement therapy: a longitudinal study.

Abstract

A retrospective study of radiologic findings from 50 postmenopausal women who underwent hormone replacement therapy was performed to determine the frequency and distribution of changes in the screen-film mammographic appearance of breast tissue between pretreatment and posttreatment mammography. Twelve (24%) of the women developed increased parenchymal density during a median follow-up of 18 months (range, 6-39 months). Mammographic changes included diffuse increase in density in seven (14%) of the women; increased multifocal, asymmetric densities in two (4%); and cyst formation in three (6%). A greater percentage of women who received estrogen-progesterone replacement (26%, 10 of 38) demonstrated changes than those who received estrogen alone (17%, two of 12), but the difference was not statistically significant. The authors conclude that benign increases in mammographic density associated with postmenopausal hormone replacement therapy are not uncommon, and they suggest that the serial changes observed in some women may diminish the sensitivity of mammography for the earlier detection of breast cancer.

Mammographic changes in postmenopausal women on hormonal replacement therapy

“…This effect showed a statistically significant difference (p = 0.045) from the oestrogen-alone group. In another retrospective study by Stomper et al [19] 50 postmeno pausal women (median age 52 years, range 40-69 years) were treated with either oestrogens alone (n = 12) or a combination of oestrogens and progestagens (n ~ 38), for a median period of 18 months (range 6-39 months). Two oestrogen-alone users (1 7 % ) and 10 oestrogen/ progestagen users (26 % ) showed increased breast den sities, but this difference was not statistically significant.…”

“…the evaluation of both an oestrogen therapy group and a com bination oestro gen/progestagen therapy group [18,19]; the median age and the median follow-up period of the populations in vestigated [18,19]; the percentage of women with an in crease in fibroglandular tissue after H R T [19]; and the statistically significant difference between the oestrogen group and the oestrogen/progestagen group [18], H ow ever, there are some differences also. In our hospitalbased study we evaluated 81 women, which is approxi mately two times more than the other two studies.…”

“…Another difference is that in our study each individual mammographic film, left and right, before and after HRT, was examined randomly and separately and classi fied according to a modified W olfe classification into one of four groups by three radiologists. In both abovementioned studies [18,19] this systematically blinded procedure was not used; instead, all m am m ographic ex aminations of the individual women before and after H R T were analysed simultaneously.…”

Interpreting hemoglobin and water concentration, oxygen saturation, and scattering measured in vivo by near-infrared breast tomography

“…T he breast is a highly heterogeneous and dynamically complex organ whose characteristics depend on factors such as age, hormonal status, habitus, family and medical history, and genetics (1)(2)(3). Normal breast tissue changes considerably during development, pregnancy, and menopause, and throughout the menstrual cycle.…”

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“…Numerous studies have reported mammographic density changes in women who start combined estrogen and progestin therapy (EPT), most have been from the US (43)(44)(45)(46)(47)(48). Two placebo-controlled randomized trials from the US, the Postmenopausal Estrogen and Progestin Interventions (PEPI) trial (46,48), and the Women's Health Initiative (WHI) trial (49) found that women assigned to the EPT arm had on average a 5% and 6% increase in mammographic density respectively after 1 year, while there were only minor changes in the placebo group or the estrogen alone arm.…”