Screening mammography: sensitivity and specificity in relation to hormone replacement therapy.

Thurfjell, Erik; Holmberg, L; Persson, Ingemar

doi:10.1148/radiology.203.2.9114085

Cited by 50 publications

(23 citation statements)

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“…6 -10 However, this was not confirmed in a Swedish study. 11 Our finding that the interval cancer cases were more frequent in HRT users than in both screening-detected and screening-normal cases supports the hypothesis that use of HRT might mask some lesions by increasing breast density and hamper the interpretation of mammograms. Screening programs will perhaps develop individual screening protocols according to breast density as proposed by Holland et al in 1982.…”

Section: Breast Density and Use Of Hrtsupporting

confidence: 80%

Interval cancers in the Norwegian breast cancer screening program: Frequency, characteristics and use of HRT

et al. 2001

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Key words: mammography screening; interval cancer; breast density; HRTAs a result of the mortality reduction found in several randomized controlled clinical trials, 1,2 breast cancer screening programs have been implemented in several western countries. 3 The Norwegian Breast Cancer Screening Program is a population-based program that offers women aged 50 -69 years biannual mammography screening. The program started as a pilot project in 4 counties in 1996, and the results from the first screening round were reported earlier. 4 Interval cancers can be defined as breast cancer diagnosed in screened women during the interval between 2 screening rounds, where the diagnosis does not follow from the screening examination. 5 The benefit of attending a screening program is reduced for women diagnosed with interval cancer. Thus the effect of a screening program in terms of mortality reduction can diminish if the frequency of interval cancer is high. This frequency depends, among other factors, on sensitivity of the test and length of the screening interval.Most interval cancers are diagnosed because of symptoms, hence interval and screening-detected cancers might be expected to have different characteristics. High breast density and use of hormone replacement therapy (HRT) have been discussed as possible contributors to reduction of screening sensitivity, and this may be related to occurrence of interval cancers. 6 -11 The purpose of our study was to quantify the interval cancers in the pilot project and to explore characteristics and factors that may be associated with interval cancer. To study the relations between use of HRT, breast density and interval cancer, data from a blinded review (breast density) and a questionnaire (use of HRT) were linked. MATERIAL AND METHODS Screening populationThe Norwegian Breast Cancer Screening Program is population based and covers women aged 50 -69 years. The screening population is identified through the Central Population Register, in which each inhabitant in Norway has a unique 11-digit number. Women are invited into the Norwegian Breast Cancer Screening Program irrespective of previous breast cancer history. The screening interval is 2 years. Two-view mammograms and independent double reading are standard. The pilot project included 4 counties with about 40% of the Norwegian female population aged 50 -69 years. During the first round (1996-97), 159,887 women born from 1927-46 were invited and 127,064 women were examined (79.5%). 4 Study subjectsWomen who had their first screening examination within the pilot project after July 31, 1998 (n ϭ 411) and women who experienced recurrence in the same breast as a previous lesion (n ϭ 6) were excluded from the study. Women who received a cancer diagnosis in the first screening round (n ϭ 854) were not included as being at risk of interval cancer. However, women who were screen-positive but cleared after assessment were included. This left 125,793 women at risk of developing interval cancer. The women were followed until the date an in...

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Section: Breast Density and Use Of Hrtsupporting

confidence: 80%

Interval cancers in the Norwegian breast cancer screening program: Frequency, characteristics and use of HRT

et al. 2001

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“…Sensitivity varied by study, screening round, and duration of interval. In all but one study, 9 sensitivity was substantially lower in current users of HRT than in non-users.…”

Section: Sensitivity Risk Of Interval Cancer and Use Of Hrtmentioning

confidence: 85%

“…The study which did not find an association between use of HRT and risk of interval cancer was relatively small and used diVerent screening methods dependent on mammographic density. 9 Although results are restricted to women of 50 and over, the lack of adjustment for potential confounding factors such as age, menopause, and time since menopause should be borne in mind when interpreting these data.…”

Section: Sensitivity Risk Of Interval Cancer and Use Of Hrtmentioning

confidence: 99%

Hormone replacement therapy and the sensitivity and specificity of breast cancer screening: a review

Banks

2001

J Med Screen

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Background-The use of hormone replacement therapy (HRT) is prevalent in the age group invited to routine breast cancer screening in many countries. Previous publications have reported reduced sensitivity and specificity of mammographic breast cancer screening associated with current use of HRT. Objectives-To review the epidemiological evidence for the relation between use of HRT and the risk of having breast cancer diagnosed between screens (interval breast cancer-sensitivity) and being recalled for assessment after initial mammography with no diagnosis of breast cancer at that screen (false positive recall-specificity). Methods-Overview of published literature. Results-Eight studies were identified, providing a total of 367 interval cancers and 8878 cases of false positive recall, in women of 50 and over. Overall, the studies showed an increased risk of interval cancer and false positive recall in current users of HRT compared with non-users. Only one study accounted for the essential confounding factors of age and menopause. Furthermore, information on duration and recency of HRT use was not available for most studies. Conclusions-Studies to date indicate that women using HRT are more likely to experience reduced sensitivity and specificity of breast cancer screening, compared with women not using HRT. However, because results have not been adjusted for crucial confounding factors, the magnitude of these eVects is uncertain. (J Med Screen 2001;8:29-35) Keywords: hormone replacement therapy; mammography; breast screening; interval cancer Hormone replacement therapy (HRT) refers to the use of estrogen or its analogues, with or without progestogen, primarily for the treatment of menopausal symptoms. Use of HRT has increased rapidly in recent years and is particularly prevalent in the age group invited to routine breast cancer screening in many countries.1 In a recent survey of women attending the United Kingdom NHS breast screening programme 33% were found to be currently using HRT and 14% were found to be past users. 2Mammographic screening is an important intervention for the early detection of breast cancer, and the ability of a screening programme to detect breast cancer at an early stage relates closely to its ability to reduce breast cancer mortality in the long term. There is evidence that women who are currently using HRT are more likely than non-users to have breast cancer which presents in the interval between screens (interval cancer). Users of HRT may therefore not experience the same benefit from screening, in terms of a reduction in breast cancer mortality, as non-users. Previous publications have also shown that, compared with non-users, women who are currently using HRT may experience more false positive recall, whereby they are recalled for assessment after initial mammography, but are subsequently found not to have breast cancer. The frequency of false positive recall is important in terms of the psychological, physical, and financial cost of a screening programme.This article aims to...

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“…Several factors that influence the risk of breast cancer, including age, use of hormone therapy, and mammographic density (1)(2)(3)(4)(5), also influence the sensitivity of mammographic screening (6)(7)(8)(9)(10)(11)(12)(13). Mammographic density is the term used to describe the appearance of radiographically dense breast tissue that appears light on a mammogram.…”

Section: Introductionmentioning

confidence: 99%

Using Mammographic Density to Improve Breast Cancer Screening Outcomes

Kavanagh

Byrnes²,

Nickson

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

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It is possible that the performance of mammographic screening would be improved if it is targeted at women at higher risk of breast cancer or who are more likely to have their cancer missed at screening, through more intensive screening or alternative screening modalities. We conducted a case-control study within a population-based Australian mammographic screening program (1,706 invasive breast cancers and 5,637 randomly selected controls). We used logistic regression to examine the effects of breast density, age, and hormone therapy use, all known to influence both breast cancer risk and the sensitivity of mammographic screening, on the risk of small (V15 mm) and large (>15 mm) screen-detected and interval breast cancers. The risk of small screen-detected cancers was not associated with density, but the risk of large screendetected cancers was nearly 3-fold for the second quintile and approximately 4-fold for the four highest density categories (third and fourth quintiles and the two highest deciles) compared with the lowest quintile. The risk of interval cancers increased monotonically across the density categories [highest decile odds ratio (OR), 4.65; 95% confidence interval (95% CI), 2.96-7.31]. The risk of small and large screen-detected cancers, but not interval cancers, increased with age.

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Screening mammography: sensitivity and specificity in relation to hormone replacement therapy.

Abstract: There was no decrease in the sensitivity of screening mammography in women currently using HRT, but there was a marginal decrease in specificity varying with the HRT regimen and duration of treatment.

Cited by 50 publications

References 0 publications

Interval cancers in the Norwegian breast cancer screening program: Frequency, characteristics and use of HRT

Interval cancers in the Norwegian breast cancer screening program: Frequency, characteristics and use of HRT

Hormone replacement therapy and the sensitivity and specificity of breast cancer screening: a review

Using Mammographic Density to Improve Breast Cancer Screening Outcomes

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