Researchers from Boston University School of Medicine (BUSM) are recommending that menopausal women on hormone therapy (HT) continue their treatment prior to having their annual mammogram screenings. These recommendations appear as an editorial in the current on-line issue of Journal of the North American Menopause Society.
Annual mammography screening is credited with a significant reduction in breast cancer mortality in women older than 50, and is considered a pillar of routine healthcare maintenance in most populations. Sensitivity, specificity, and optimal performance of mammography depend on a number of variables including breast density. While subjective and objective increases in mammographic breast density have been reported in up to 30% of postmenopausal women taking HT, the majority of women in this age group have low breast densities to start with and the magnitude of the increase with HT is small in most. Furthermore, improvements in screening technologies (digital mammography) have shown promise in overcoming hindrances in denser breasts. It is thus extremely unlikely that a minor increase in density is going to mask the mammographic detection of any early breast cancer if present.
“We do not believe everyone on HT should consider stopping treatment one to two months prior to their mammogram,” said lead author Raja Sayegh, MD, an associate professor of obstetrics and gynecology at BUSM. “Such a practice is likely to precipitate the recurrence of nuisance symptoms for which most menopausal women take HT nowadays, with no convincing evidence of improved screening accuracy. While there may be other good reasons to consider stopping HT, improving the mammographic detection of early cancers should not be one of them,” he added.
Instead, the researchers recommend that health care providers should alert their HT patients to the possibility of an augmented mammographic density, or other artifacts, that may require additional evaluation. “This should become part of the office routine, as it has become part of mammography reporting routine. Women who have thus been alerted, are less likely to be ridden with fear and anxiety when they receive a recall notice from the mammography department,” said Sayegh.