Hormone Therapy and Breast Imaging: Awareness and Understanding

Linda Giering, PhD*

*Medical Writer, Matawan, New Jersey

Address correspondence to: Linda Giering, PhD. Email: lindagiering@gmail.com.

Disclosure statement: The author reports having no significant financial or advisory relationships with corporate organizations related to this activity.


Hormone replacement therapy (HRT) is an effective treatment for symptoms of menopause.  Studies have shown HRT increases breast cancer risk and mammographic density. The risks of HRT differ depending on whether estrogen or estrogen plus progestin are used, the administered dose, age and timing of initiation, duration of use, route of administration, and individual patient's other risk factors.

Mammography is the mainstay of breast screening for women aged 40 and over but is less effective in women under 50 years of age and in women with dense breasts. Women with dense breasts are at increased risk of breast cancer independent of taking HRT. Cancers detected in women with dense breasts are larger, often node positive, and interval cancers are 18 times more likely to occur. High-risk populations  (women with a lifetime risk of greater than 20%-25%) are advised to undergo additional annual surveillance with magnetic resonance imaging (MRI) or, if they cannot undergo MRI, consider screening breast sonography. However, there is a gap in the approach to screening non-high risk or average high-risk women such as HRT users who span the spectrum of risk for breast cancer based on their individual profile. Given the prevalence of dense breast tissue and the challenges of identifying cancer in women with dense breasts using mammography, additional imaging modalities to detect mammographically occult breast cancer may be needed. Results of clinical trials on the use of HRT, recommendations for the use of HRT, the role of breast screening modalities, and the importance of individualized screening strategies will be reviewed.

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