Factors associated with non-compliance with hormone therapy cessation before screening mammography

Abstract

Objectives To evaluate factors associated with non-compliance with discontinuation of hormone therapy (HT) within a study on the effect of HT cessation on mammography performance.Methods This randomized, controlled trial was conducted at Group Health, a health plan in Washington State, USA. Eligibility included: age 45–80 years; due for screening (‘study’) mammogram; and prior screening mammogram while using HT. We randomized 1704 women to no cessation (n = 567), 1-month (n = 570), or 2-month cessation (n = 567), and called participants before cessation to review instructions. We collected self-reported data at randomization (baseline) and before the study mammogram, including symptoms and compliance. This analysis includes women randomized to 1-month or 2-month cessation with complete baseline and follow-up questionnaires (n = 883).Results Most participants were using unopposed estrogen (63.3%) and intended to continue HT (90%); 9.6% were non-compliant with HT cessation. Comparing 2-month vs. 1-month cessation, the age and body mass index (BMI)-adjusted relative risk (RR) for non-compliance was 1.72 (95% confidence interval (CI) 1.12–2.60). Baseline variables associated with non-compliance included: age ≤55 vs. >55 years (RR 2.34; 95% CI 1.34–4.41); BMI < 25 vs. BMI ≥30 kg/m (RR 1.63; 95% CI 1.01–2.63); unopposed estrogen vs. estrogen plus progestin (RR 1.59; 95% CI 1.01–2.51); using HT to manage sleep (RR 1.80; 95% CI 1.20–2.71); severe vs. no night sweats (RR 1.68; 95% CI 1.03–2.74); and night sweats that interfered with sleep (RR 1.78; 95% CI 1.02–3.11).Conclusions Non-compliance with HT cessation before screening mammogram was associated with younger age, lower BMI, symptom severity and use of unopposed estrogen. Alternatives for menopause symptom management are needed to assist women with HT cessation.