Mammography and Hormone Replacement Therapy

Mammography is the best tool available for the early detection of breast cancer. But, a new study out this week suggests mammogram screenings can be more difficult in women who use hormone replacement therapy during menopause. CBS News Health Contributor and American Red Cross President, Dr. Bernadine Healy explains.

1. What did this study find?

The study looked at pharmacy records of some 5,000 women between the ages of 40 and 96. Roughly 2,000 of these women were taking hormones, mostly the estrogen/progestin combination, for at least three months. Researchers then compared their use of HRT to their breast density readings on mammograms. They found that up to 30 percent of these women using HRT had thickened breast tissue. Thus, concluding that this would make it more difficult to spot tumors on X-rays.

2. Does this mean women should stop using hormone replacement therapy?

No. It's really too early to recommend that women stop using the therapy for the sake of more accurate mammograms. We still need a lot more research on this. Some 20 million women in this country take hormones at menopause. While many use them to relieve temporary menopause symptoms such as hot flashes and night sweats, others take them for years because of evidence that they ease many signs of aging such as thinning bones, memory loss and cholesterol increases. Also, we don't know what the risks of going on and off HRT are.

3. How does a woman know if she has dense breast tissue?

If a woman is concerned about this, she should ask her mammographer. The mammographer can tell by examining the mammogram. Dense opaque tissue shows up white on mammograms compared with the grayish color of fat. Most women who are on HRT don't have very dense breasts since the older they get the less glandular tissue and more fat they get in the breasts.

4. If a woman is on hormone replacement therapy and has dense breast tissue, is there anything she can do?

It's important to understand that mammography is only one method in detecting breast cancer. For all women, the key to reducing the breast cancer death rate is still early detection! That involves a combination of mammography, clinical breast examination and breast self-examination. This combined approach is clearly better than any one exam. Breast physical examination without mammography would miss the opportunity to detect many breast cancers that are too small for a woman or her doctor to feel, but can be seen on mammograms. Although mammography is the most sensitive screening method, a small percentage of breast cancers do not show up on mammograms, but can be felt by a woman or her doctor.

5. When should a women get a mammogram?

Women age 50 and older should get a mammogram every year. They should also get a breast exam by a health professional every year. Women between the ages of 20 and 30 should have a clinical breast exam by a health profesional every three years. And, all women age 20 or older should perform a breast self-examination every month.

6. Have there been any advances in mammography?

Modern mammography has been around only since 1969. That was the first year X-ray units dedicated to breast imaging were available. Last fall, the Food and Drug Aministration (FDA) approved doctors to use mammography to screen and diagnose patients for breast disease directly from an advanced computer workstation instead of reading traditional X-ray films. The procedure is called "soft copy" reading. It allows doctors to zoom in and enhance images so they can see the difference in contrast between the lesion and surrounding tissues.

7. This week, the fda approved a new drug to fight late-stage cancer. What can you tell us about it?

Femara, known chemically as letrozole, is an alternative to the longtime standard therapy, tamoxifen, in treating metastatic breast cancer, the kind that has spred through the body. Fermara is not a wonder drug, but a study did find that compared to tamoxifen, Femara provided an average of 3.6 more months before tumors worsened, although there's no proof yet that it helps patients live any longer. Overall, the risk of disease worsening was 30% less among Femara patients than tamoxifen patients. Experts call that meaningful time for such late-stage cancer, particularly because it lets women postpone consideration of more toxic chemotherapy.