Short-term Cessation of Hormone Replacement Therapy and Improvement of Mammographic Specificity

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A recent study by Laya et al. ( 1 ), comparing 8779 current, never, and former users of hormone replacement therapy (HRT), found a significant reduction in both the sensitivity and the specificity of mammography associated with current hormone administration. An accompanying editorial ( 2 ) suggested that the effects of HRT should be reversible, since the specificity and sensitivity for former users were identical to those for never users.

HRT causes an increase in mammographic density in 17%–73% of women that may be diffuse, focal, or multifocal ( 3 – 6 ). While diffuse or multifocal changes are not worrisome, new or enlarging focal, circumscribed masses or developing densities can be a sign of early breast carcinoma and may prompt biopsy ( 7 – 11 ). Biologic data demonstrate rapidly reversible stimulatory effects of estrogens and progestins on mammary cell proliferation, both during the menstrual cycle and in hormonally deprived women ( 12 ). Therefore, as a routine practice, we have attempted to reverse focal mammographic changes that may be hormone induced by empirically discontinuing HRT for 2 weeks prior to biopsy. Our data suggest that short-term HRT cessation can induce regression of hormone-induced mammographic changes, and unnecessary biopsy can be avoided.