Drüsenkörperdichte und Mammakarzinomrisiko unter HRT

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

Literatur

• 1 American College of Radiology .The ACR breast imaging reporting and data system (BI-RADS®). 4th ed. Reston, VA 2003
• 2 Baines C J, Vidmar M, McKeown-Eyssen G, Tibshirani R. Impact of menstrual phase on false-negative mammogramms in the Canadian National Breast Screening Study.  Cancer. 1997;  80 720-724
• 3 Banks E, Reeves G, Beral V, Bull D, Crossley B, Simmonds M, Hilton E, Bailey S, Barrett N, Briers P, English R, Jackson A, Kutt E, Lavelle J, Rockall L, Wallis M G, Wilson M, Patnick J. Impact of use of hormone replacement therapy on false positive recall in the NHS breast screening programme: results from the million women study.  BMJ. 2004;  328 291-292
• 4 Boyd N F, Martin L J, Stone J, Greenberg C, Minkin S, Yaffe M J. Mammographic densities as a marker of breast cancer risk and their use in chemoprevention.  Current Oncology Reports. 2001;  3 314-321
• 5 Brisson J, Brisson B, Cote G, Maunsell E, Berube S, Robert J. Tamoxifen and mammographic breast densities.  Cancer Epidemiology, Biomarkers & Prevention. 2000;  9 911-915
• 6 Carney P A, Miglioretti D L, Yankaskas B C, Kerliowske K, Rosenberg R, Rutter C M, Geller B M, Abraham L A, Taplin S H, Dignan M, Cutter G, Ballard-Barbash R. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography.  Ann Intern Med. 2003;  138 168-175
• 7 Christodoulakos G E, Lambrinoudaki I V, Panoulis K P, Vourtsi A D, Vlachos L, Georgiou E, Creatsas G C. The effects of various regimens of hormone replacement therapy on mammographic breast density.  Maturitas. 2003;  45 109-118
• 8 Christodoulakos G E, Lambrinoudaki I V, Vourtsi A D, Panoulis K PC, Kelekis D A, Creatsas G C. Mammographic changes associated with raloxifen and tibolone therapy in postmenopausal women: a prospective study.  Menopause. 2002;  9 110-116
• 9 Colacurci N, Fornaro F, De Franciscis P, Mele D, Palermo M, del Veccio W. Effects of a short-term suspension of hormone replacement therapy on mammographic density.  Fertil Steril. 2001;  76 451-455
• 10 Colacurci N, Fornaro F, De Franciscis P, Palermo M, del Vecchio W. Effects of different types of hormone replacement therapy on mammographic density.  Maturitas. 2001;  40 159-164
• 11 El-Bastawissi A Y, White E, Mandelson M T, Taplin S H. Reproductive and hormonal factors associated with mammographic breast density by age (US).  Cancer Causes Control. 2000;  11 955-963
• 12 Greendale G A, Reboussin B A, Sie A, Singh H R, Olson L K, Gatewood O, Bassett L W, Wasilauskas C, Bush T, Barrett-Connor E. Effects of estrogen and estrogen-progestin on mammographic parenchymal density. Postmenopausal Estrogen/Progestin Interventions (PEPI) Investigators.  Ann Intern Med. 1999;  130 262-269
• 13 Haiman C A, Bernstein L, den Berg D van, Ingles S A, Salane M, Ursin G. Genetic determinants of mammographic density.  Breast Cancer Research (breast-cancer-research.com/content/4/3/R5). 2002;  4 R5
• 14 Kavangh A M, Mitchell H, Giles G G. Hormone replacement therapy and accuracy of mammographic screening.  Lancet. 2000;  355 270-274
• 15 Kuhl H. Epidemiologie, Mammakarzinom und Hormonersatztherapie.  J Menopause. 2003;  4 6-10
• 16 Laya M B, Larson E B, Taplin S H, White E. Effect of estrogen replacement therapy on the specificity and sensitivity of screening mammography.  J Natl Cancer Inst. 1996;  88 643-649
• 17 Litherland J C, Stallard S, Hole D, Cordiner C. The effect of horomone replacement therapy on the sensitivity of screening mammograms.  Clin Radiol. 1999;  54 285-288
• 18 Lundström E, Wilczek B, Palffy Z von, Söderqvist G, Schoultz B von. Mammographic breast density during hormone replacement therapy: Effects of continuous combination, unopposed transdermal and low-potency estrogen regimens.  Climacteric. 2001;  4 42-48
• 19 Lundström E, Christow A, Kersemaekers W, Svane G, Azavedo E, Söderqvist G, Mol-Arts M, Barkfeldt J, Schoultz B von. Effects of tibolone and continuous combined hormone replacement therapy on mammographic breast density.  Am J Obstet Gynecol. 2002;  186 717-722
• 20 Lundström E, Wilczek B, Palffy Z von, Söderqvust G, Schoultz B von. Mammographic breast density during hormone replacement therapy: Differences according to treatment.  Am J Obstet Gynecol. 1999;  181 348-352
• 21 Mascarinec G, Meng L, Ursin G. Ethnic differences in mammographic densities.  Internat J Epidemiology. 2001;  30 959-965
• 22 Persson I, Thurfjell E, Holmberg L. Effect of estrogen and estrogen/progestin replacement regimes on mammographic breast parenchymal density.  J Clin Oncol. 1997;  15 3201-3207
• 23 Perry N M. EUSOMA Working Party . Quality assurance in the diagnosis of breast disease.  European J Cancer. 2001;  37 159-172
• 24 Rosenberg R D, Hunt W C, Williamson M R, Gilliland F D, Wiest P W, Kelsey C A, Key C R, Linver M N. Effets of age, breast density, ethnicity, and estrogen replacement therapy on screening mammographic sensitivity and cancer stage at diagnosis: review of 183 134 screening mammograms in Albuquerque, New Mexico.  Radiology. 1998;  209 511-518
• 25 Sala E, Warren R, McCann J, Duffy S, Luben R, Day N. High-risk mammographic parenchymal patterns, hormone replacement therapy and other risk factors: a case-control study.  Int J Epidemiol. 2000;  29 629-636
• 26 Sala E, Solomon L, Warren R, McCann J, Duffy S, Luben R, Day N. Size, node status and grade of breast tumors: association with mammographic parenchymal patterns.  Eur Radiol. 2000;  10 157-161
• 27 Sendag F, Terek M C, Özsener S, Öztekin K, Bilgin O, Bilgen I, Memis A. Mammographic density chages during different postmenopausal hormone replacement therapies.  Fertil Steril. 2001;  76 445-450
• 28 Seradour B, Esteve J, Heid P, Jacquemier J. Hormone replacement therapy and screening mammography: analysis of the results in the Bouches du Rhone programme.  J Med Screen. 1999;  6 99-102
• 29 Sivaramakrishna R, Obuchowski N A, Chilcote W A, Powell K A. Automatic segmentation of mammographic density.  Acad Radiol. 2001;  8 250-256
• 30 Sterns E E, Zee B. Mammographic density changes in perimenopausal and postmenopausal women: is effect of hormone replacement therapy predictable?.  Breast Cancer Res Treat. 2000;  59 125-132
• 31 Ursin G, Parisky Y R, Pike M C, Spicer D V. Mammographic density changes during the menstrual cycle.  Cancer Epidemilogy, Biomarkers & Prevention. 2001;  10 141-142
• 32 Gils C H Van, Otten J D, Verbeek A L, Hendriks J H, Holland R. Effect of mammographic breast density on breast cancer screening performance: a study in Nijmwegen, The Netherlands.  J Epidemiol Community Health. 1998;  52 267-271
• 33 Wolfe J N. Risk for breast cancer development determined by mammographic parenchymal pattern.  Cancer. 1976;  37 2486-2492