Using Hormonal Strategies To Improve Mammographic Density And Sensitivity Of Screening Mammograms

Early oophorectomy, tamoxifen treatment, a GnRHA-based regimen, and cessation of HRT use would be expected to increase mammo-graphic sensitivity and, possibly, reduce breast cancer risk. However, only certain women at very high risk of breast cancer are likely to opt for tamoxifen or early oophorectomy and then only after completing childbearing. Treatment with a GnRHA-based regimen could represent an option for young women who still would like to have children.34

It is possible that the benefit of such hormonal strategies varies substantially. It is clear that not everyone who takes a GnRHA regimen has a reduction in density,36 just as not everyone who starts EPRT has an increase.51 The biological or genetic predictors of mammographic density changes with hormonal alterations are currently unknown. Thus, in the absence of such predictive markers, the best clinical approach currently to improve the screening benefit in a young woman with dense breasts would be to simply test whether a temporary endogenous hormone reduction will result in a reduced amount of density on her mammogram. For premeno-pausal women, a reversible approach, such as a GnRHA-based regimen, ought to be attempted first. Women with a substantial reduction in mammographic density with a GnRHA-based regimen may be more likely to benefit from ta-moxifen treatment or early oophorectomy than women who do not have density reduction with such hormonal manipulation. Postmenopausal women who have substantial increases in density when they start HRT may similarly benefit from temporary cessation of the therapy prior to their screening mammogram.

There may be women in whom reducing hormone levels will not result in reduced density. For such women and for women who due to medical (high cholesterol) or other reasons do not wish to reduce their hormone levels, alternative imaging techniques, currently being developed and tested, may be a good alternative.52

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