Breast Cancer Diagnosis Complicated by Hormone Therapy

By: Red Hot Mamas

Published: June 25, 2010

I am learning more and more that abnormal mammograms are not uncommon, especially for women on hormone therapy. We have known for several years that hormone therapy can slightly increase your risk of developing breast cancer. But, news just broke that for women on hormone therapy, mammograms and biopsy exams were found to be less reliable at detecting breast cancer.

The study was published in the latest February 25 th edition of the Archives of Internal Medicine and examined the effect of combined hormone therapy on breast cancer detection over 5.6 years. Findings showed 35 percent of women taking hormones had mammograms with abnormal results. Ten percent of those women were ordered by their doctors to have breast biopsies. For women in the study taking a placebo, 23 percent had abnormal mammograms with 6 percent of them receiving biopsies. Biopsies in the hormone group diagnosed cancer less frequently compared with the placebo group (14.8 versus 19.6 percent).

Dr. Rowan Chlebowski, lead author of the study, of the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center explains, “What this data does is emphasize that yes, the breast cancer risk is still there, but more importantly, instead of that low number of one in 1,000 getting breast cancer, one in 10 women are told they had an abnormal mammogram they’ll have to deal with, and probably even more importantly, one in 25 women will have an otherwise avoidable breast biopsy”.

Another study hit the press that was published in the Journal of the American Medical Association. Conducted by Dr. Wendie Berg of American Radiology Services at Johns Hopkins in Lutherville, MD involving 2,809 women 25 or older. They were examined from April 2004 to February 2006 and all underwent either a mammogram alone or a mammogram and ultrasound. Results showed that within the first year of screening, breast cancer was diagnosed in 40 women. Mammography alone found 12 cancers, and mammography with ultrasound found 20.

Using ultrasound, in addition to mammography, significantly helps detect breast cancers rather than just using mammography alone. However, within this study, there was an increase in the rate of false positives which rose to 1 in 10 women requiring unnecessary biopsy. In essence, clinicians need to determine whether it makes sense to use ultrasound as a routine test for breast cancer. There is additional cost involved to the patient, as well as additional stress involved.

These study’s findings didn’t change what is already known about the breast cancer risk from hormone therapy but it is still important information for women who are considering taking hormone therapy. I have been on estrogen since 1991 following a hysterectomy with removal of my ovaries (oophorectomy). Data from the Women’s Health Initiative (WHI) study showed women (in the estrogen only part of the study) actually had a slightly lower breast cancer rate than that of women who weren’t taking hormones. This data was reassuring to me and I hope that I will fall into this category. Abnormal mammograms can lead to unnecessary biopsies, can cause great distress and emotional repercussions that I am personally facing right now.

This subject is of particular interest to me as in January I had a routine mammography. Several days later I was called back to take additional films of my right breast and it was recommended I also have a sonogram . There were different interpretations from the mammography, the additional films and the sonogram due to the higher density of my breast, so the radiologist recommended an MRI (a very costly procedure about $3,500). After the MRI was done, I was told I would need an MRI guided biopsy. Since the findings on all these studies of my breast were not conclusive, I made the decision to see a breast specialist who suggested I not have the biopsy at this time, but come back and repeat the MRI scanning again in six months. Obviously he was not totally convinced of the screenings.

The most frightening thing about my situation: I simply do not know what will become of all this, or what I may be facing. Even as a health care educator, I truly confess to being very nervous and worried. I’ve had no breast symptoms, but certainly now have a lot of fears, which are causing me to be in a funk, and that’s probably why I am feeling a bit listless. It is my hope that the scheduled MRI will prove to be a benign breast problem, but I will not know the outcome of this, until the MRI is performed. I have learned from all of this, that mammography has its limits.

References:

Rowan T. Chlebowski; Garnet Anderson; Mary Pettinger; Dorothy Lane; Robert D. Langer; Mary Ann Gillian; Brian W. Walsh; Chu Chen; Anne McTiernan; for the Women’s Health Initiative Investigators. Estrogen Plus Progestin and Breast Cancer Detection by Means of Mammography and Breast Biopsy. Arch Intern Med. 2008;168(4):370-377.

Mammogram With Ultrasound Improved Detection of Cancers, New York Times, May 14, 2008.

Paddock, C., Hormone Therapy Compromised Breast Cancer Diagnosis Via Mammogram and Biopsy, Medical News Today; 26 Feb 2008.

Stern, A., Hormone Therapy Skews Breast Cancer Dianosis, Reuters Health; Feb 25 2008, 1p.

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