Hormonsubstitution und Mammakarzinomscreening

Abstract

Hormone replacement therapy (HRT) is associated with reduced sensitivity and specificity of mammography, probably due to increased breast density. The increase in breast density depends on the particular HRT regimen, with continuous combined HRT associated with the largest increase. In addition, women on HRT have a higher incidence of mastalgia compared with women not using HRT. This may also contribute to the reduced sensitivity and specificity of mammography, because adequate compression of the breast may be less likely in these women. There is also evidence that women with HRT develop a higher proportion of lobular carcinomas, which are less likely to be detected by mammography than ductal carcinomas. Short-term cessation of HRT before mammography can reduce breast density, but whether cessation can compensate for the HRT-mediated loss of sensitivity and specificity is unclear. Tibolone, as an alternative to estrogen-containing HRT, is associated with reduced breast density but there are as yet no data on the sensitivity and specificity of mammography in women taking tibolone. In summary, these data support the omission of continuous combined HRT, the cessation of HRT 2-4 weeks before mammography, and the use of tibolone, especially in women with dense breasts. However, the effect of these interventions on the sensitivity and specificity of mammography are unproven.