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International Breast Screening Network, Ottawa, Canada May 11 – 12, 2006. Mammographic screening performance over time: influence of breast density and hormone replacement therapy. Broeders MJM, Otten JDM, Zee N van der, Verbeek ALM Department of Epidemiology and Biostatistics

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Mammographic screening performance over time: influence of breast density and hormone replacement therapy

Broeders MJM, Otten JDM, Zee N van der, Verbeek ALM

Department of Epidemiology and Biostatistics

Radboud University Nijmegen Medical Centre

Nijmegen, The Netherlands


Background
Background breast density and hormone replacement therapy

  • Mammographic imaging techniques have improved considerably over time

  • Screening performance in dense vs. lucent breast patterns

  • Increased use of HRT associated with:

    • increased breast cancer incidence

    • higher breast density lower Se, Sp

    • breast pain inadequate compression

      (Kavanagh)

MJM Broeders, IBSN 2006


Study objectives
Study objectives breast density and hormone replacement therapy

  • To compare screening performance in women aged 49–69 years with dense and lucent breast patterns in two time periods

  • To study the possible interaction with use of HRT

MJM Broeders, IBSN 2006


Setting
Setting breast density and hormone replacement therapy

  • Nationwide screening programme since 1989

    • target group: 50–74 (50–69 until 1998)

    • biennial screening mammography

    • personal invitation (with reminder)

    • double reading

    • referral to GP (no recall)

  • National co-ordination—regional execution

  • Nine screening regions

MJM Broeders, IBSN 2006


Study populations 1
Study populations (1) breast density and hormone replacement therapy

  • Women aged 49–69 years

  • Period 1994–1995: regional screening programme

  • Period 2001–2002: Nijmegen

MJM Broeders, IBSN 2006


Data collection
Data collection breast density and hormone replacement therapy

  • HRT— questionnaire at screening

  • Breast density

    • mammograms digitised

    • computer-assisted methods

    • dense > 25%

  • Screening outcomes

MJM Broeders, IBSN 2006


Study populations 2
Study populations (2) breast density and hormone replacement therapy

MJM Broeders, IBSN 2006


Screening performance
Screening performance breast density and hormone replacement therapy

MJM Broeders, IBSN 2006


Screening performance over time
Screening performance over time breast density and hormone replacement therapy

MJM Broeders, IBSN 2006


Screening performance over time breast pattern
Screening performance over time, breast pattern breast density and hormone replacement therapy

MJM Broeders, IBSN 2006


Screening performance 1994 1995 hrt
Screening performance 1994 breast density and hormone replacement therapy–1995, HRT

MJM Broeders, IBSN 2006


Screening performance 2001 2002 hrt
Screening performance 2001 breast density and hormone replacement therapy–2002, HRT

MJM Broeders, IBSN 2006


Summary
Summary breast density and hormone replacement therapy

  • Screening performance:

    • improved slightly over time

    • difference dense – lucent still exists

    • worse in women on HRT, especially with

      dense patterns

  • However: 2001–2002 small group with few women on HRT

MJM Broeders, IBSN 2006


Discussion
Discussion breast density and hormone replacement therapy

  • Other factors:

    • age

    • BMI

    • first / subsequent screening

  • Future research:

    • increase control group 2001–2002

    • measure direct influence of HRT on technical

      quality

    • transition to digital screening (baseline)

MJM Broeders, IBSN 2006


International Breast Screening Network, Ottawa, Canada breast density and hormone replacement therapy

May 11–12, 2006


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