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Should Women Stop HT Temporarily Before Undergoing Screening Mammography?

Suspending HT for 1 or 2 months did not lower mammography recall rates, but did increase likelihood of experiencing vasomotor symptoms.

Because hormone therapy is associated with higher breast density, some clinicians have recommended that users temporarily suspend HT before undergoing screening mammography. In a federally funded trial, investigators recruited women who were using HT at the time of their most recent (i.e., index) screening mammograms and were still using HT when their next screens were due. Almost two thirds of 4884 eligible women declined to participate, primarily because they were unwilling to suspend HT use. Others were randomized to no suspension or to 1- or 2-month suspension of HT before screening mammography. Of 1471 participants (mean age, 60), 92% were white.

Recall rates were similar in the no-suspension (11%), 1-month suspension (12%), and 2-month suspension (10%) groups. Although suspension of HT was associated with significantly lower mammographic breast density, these changes in density did not affect mammography recall rates. HT suspension was associated with significantly greater likelihood of hot flashes (reported by about half of participants at baseline and by >85% of participants who were randomized to HT suspension [P<0.001]).

Comment: More than 10% of women who undergo screening mammography are advised to return for additional imaging, resulting in anxiety, inconvenience, and additional costs; however, at least 95% of recalls are not associated with diagnoses of breast cancer within 1 year. Higher breast density is associated with lower mammographic sensitivity and specificity. Because HT (particularly combination estrogen-progestin HT) can increase breast density, the concept of suspending HT use before mammography screens has garnered attention. In that light, two important points emerge from this trial: Short-term HT suspension does not lower mammographic recall rates, and most HT users are not willing to suspend their use of HT.

— Andrew M. Kaunitz, MD

Published in Journal Watch Women's Health June 25, 2009

Citation(s):

Buist DSM et al. Short-term hormone therapy suspension and mammography recall. A randomized trial. Ann Intern Med 2009 Jun 2; 150:752.

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