Zusammenfassung
Eine erhöhte Drüsenkörperdichte ist mit einem erhöhten Mammakarzinomrisiko verbunden bei gleichzeitig reduzierter Sensitivität der wichtigsten Früherkennungsdiagnostik, der Mammographie. Exogen zugeführte Hormone können bei bis zu ⅓ der behandelten Frauen zu einer Zunahme der Drüsenkörperdichte führen. Östrogen-Gestagenkombinationen zeigen einen deutlicheren Einfluss als reine Östrogenpräparate. Die Dichteveränderungen treten bereits innerhalb des 1. Anwendungsjahres in Erscheinung und scheinen durch Absetzen der HRT reversibel innerhalb weniger Wochen. Als mögliche Auswege aus dem skizzierten Dilemma erscheint es daher sinnvoll, mammographische Untersuchungen insbesondere asymptomatischer prämenopausaler Frauen in der 1. Zyklushälfte durchzuführen; darüber hinaus bei Frauen mit dichtem Drüsengewebe unter Einnahme einer HRT entweder die Zusammensetzung der HRT zu modifizieren, die Applikationsform zu ändern oder die HRT vor der geplanten Mammographie für einen Zeitraum von ca. 3 Wochen abzusetzen. In der kurativen Situation, d. h. bei symptomatischen Patientinnen mit dichtem Drüsengewebe, ist die additive Sonographie obligat, um die potenziell hohe Rate falsch-negativer Befunde zu reduzieren [23].
Abstract
Higher breast density leads to a higher risk of breast-cancer coming along with a reduced sensitivity of mammography, the most important method for early diagnosis of breast cancer. HRT leads to an increase in breast density in up to ⅓ of treated women. Combined regimes of estrogen-progestin show a stronger influence than estrogen only. Changes of breast density appear almost entirely within the first year of administration and seem to be reversible after suspension of treatment within a few weeks. A possible solution of the dilemma is to perform mammography in asymptomatic premenopausal women during the first half of the menstrual cycle. In women with increased breast density using HRT it is recommended to modify the combination of hormones, change the application mode, or suspend HRT for a short period of 3 weeks prior to mammography. In symptomatic women with dense breasts, additive breast ultrasound is strongly recommended to reduce the otherwise high rate of missed breast cancers.
Schlüsselwörter
HRT - Mammakarzinom - Mammographie - Drüsenkörperdichte
Key words
HRT - breast-cancer - mammography - breast density
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Dr. K. Bock
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