British Menopause Society
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Fact Sheets: Article

Title: Mammograms and HRT

Dr Jenny Williamson, Associate Breast Specialist. January 2006, reviewed January 2008

What are Mammograms?

A mammogram is an X ray of your breast. It is the most reliable method used to screen for breast cancer, and to find small changes in the breast before there are any other signs or symptoms.

When should I have a mammogram?

All women between 50 and 70 years are invited to attend for a mammogram (breast screening) once every 3 years. Younger women are not routinely invited as they generally have more dense breasts, making the interpretation of the x-ray more difficult.

As a rule mammograms are not done on women under the age of 35 years as the chance of detecting abnormalities is small and there is concern about exposing the breast to radiation (although this is very small) at an early age.

What if I have relatives who have had breast cancer?

If there is a history of breast cancer in your family, then you should consult your doctor to determine if you are at a higher risk of developing breast cancer at a younger age. If this is so then you may be advised to commence screening before age 50 years.

Do I need a mammogram before I take HRT?

Provided you have no breast symptoms, there is no need to have a mammogram before starting HRT, and it is not necessary to have more frequent mammograms while taking HRT.

Which HRT preparations do I need?

There are many forms of HRT.

Women who have had their womb removed will only need estrogen replacement while those who have not had such surgery will need both estrogen and progestogen. There are different regimens and your doctor can advise the most appropriate one for you.

Can HRT affect the interpretation of mammograms?

As women get older the glandular breast tissue, (which appears white on a mammogram), reduces and the amount of fat (which appears black on a mammogram), increases. A small percentage of women have been found to have consistently dense breasts even with advancing age. Breast cancers can appear on a mammogram as an isolated focus of increased density. When these are small the patient benefits from having early detection of the cancer. These small foci may be more difficult to detect in a woman with generalised increased density

Some HRT preparations can increase the breast density seen on mammograms. Current evidence from clinical trials suggests that about 1 in 4 women who use combined HRT (estrogen and progestogen) show this general increase in density. Estrogen on its own does not appear to affect the density. Tibolone, another form of treatment for menopausal symptoms, does not appear to have any significant effect either.

Will breast screening be effective if I am taking HRT?

Although mammography is the most reliable way of detecting breast cancer early, it is not perfect as some cancers can be very difficult to see, and a small number of cancers, even if present, are not seen on x-ray at all. If the person reading the x-ray finds a significant change in the density since your previous x-ray, then you may be asked to attend for a further assessment.*

Only 1 in 10 women recalled for further assessment in the national breast screening program will be found to have a significant abnormality.

Will I experience more pain during the procedure if I am taking HRT?

Some women find the procedure uncomfortable or painful as the breasts have to be held firmly in position and pressed to take a good x-ray. This is usually transient. There is no evidence that women established on HRT find the procedure more painful than those who do not take HRT

* What does having further assessment mean?

You will be asked to attend the screening centre for further tests which may involve having more X rays taken of your breasts or another test with ultrasound. You may have an examination by a doctor and if any other test is required then this will be explained to you beforehand.

What is Ultrasound?

This technique uses high frequency sound waves which are reflected back and translated into a picture or image. It is safe but not used as a means of screening all women as it is less accurate than mammograms. It is most useful in determining the outline of a lump and whether it is solid or cystic (fluid filled).

Useful addresses /websites:

The British Menopause Society
is a registered charity dedicated to increasing awareness of post-menopausal healthcare issues
(this site).   www.thebms.org.uk

NHS cancer Screening Programme
www.cancerscreening.nhs.uk

Women's Health Concern advice and up to date information on women's health issues Advice line Tel 0845 1232319
www.womens-health-concern.org.uk

Menopause Matters
accurate information about the menopause and its treatment options
www.menopausematters.co.uk

Whilst great care has been taken to ensure the accuracy of information contained in the fact sheets, the authors and the BMS cannot accept any responsibility for any errors omissions, mis-statements or mistakes or for any loss or damage arising from actions or decisions based on information contained in this publication. Ultimate responsibility for the treatment of patients and interpretation of published material lies with the medical practitioner. The opinions expressed are those of the authors, not necessarily those of the BMS. The inclusion in the publication of material relating to a particular product, method or technique does not amount to an endorsement of its value or quality, or of claims made by its manufacturer.
Margaret Rees and Sally Hope January 2008

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