Estrogen plus progestin and breast cancer detection by means of mammography and breast biopsy
| Autor: | Rowan T, Chlebowski, Garnet, Anderson, Mary, Pettinger, Dorothy, Lane, Robert D, Langer, Mary Ann, Gilligan, Mary Ann, Gillian, Brian W, Walsh, Chu, Chen, Anne, McTiernan, Susan, Hendrix |
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| Rok vydání: | 2008 |
| Předmět: |
Breast biopsy
medicine.medical_specialty medicine.medical_treatment Biopsy Urology Breast Neoplasms Medroxyprogesterone Acetate Breast cancer Internal Medicine medicine Medroxyprogesterone acetate Mammography Humans Aged Gynecology Estrogens Conjugated (USP) medicine.diagnostic_test business.industry Estrogen Replacement Therapy Cancer Hormone replacement therapy (menopause) Estrogens Middle Aged medicine.disease Drug Therapy Combination Female Hormone therapy Breast disease Progestins business medicine.drug |
| Zdroj: | Archives of internal medicine. 168(4) |
| ISSN: | 0003-9926 |
| Popis: | The effect of combined hormone therapy on breast cancer detection is not established.We examined the effect of combined hormone therapy on breast cancer detection in the Women's Health Initiative trial, which randomized 16,608 postmenopausal women to receive conjugated equine estrogens (0.625 mg/d) plus medroxyprogesterone acetate (2.5 mg/d) or placebo. Mammography and breast examinations were performed at baseline and annually per protocol, with breast biopsies based on clinical findings. The effects of conjugated equine estrogens plus medroxyprogesterone acetate on breast cancer detection was determined throughout 5.6 years of intervention using receiver operating characteristic analyses to evaluate mammography results.Conjugated equine estrogens plus medroxyprogesterone acetate increased the cumulative frequency of mammograms with abnormalities vs placebo (35.0% vs 23.0%; P.001), which had less sensitivity for cancer detection and increased cumulative breast biopsy frequency (10.0% vs 6.1%; P.001). Although breast cancers were significantly increased and were diagnosed at higher stages in the combined hormone group, biopsies in that group less frequently diagnosed cancer (14.8% vs 19.6%; P = .006). After discontinuation of combined hormone therapy, its adverse effect on mammograms modulated but remained significantly different from that of placebo for at least 12 months (P.001).Use of conjugated equine estrogens plus medroxyprogesterone acetate for approximately 5 years resulted in more than 1 in 10 and 1 in 25 women having otherwise avoidable mammogram abnormalities and breast biopsies, respectively, and compromised the diagnostic performance of both. This adverse effect on breast cancer detection should be incorporated into risk-benefit discussions with women considering even short-term combined hormone therapy.clinicaltrials.gov Identifier: NCT00000611. |
| Databáze: | OpenAIRE |
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