J Med Screen. 2001;8(1):29-34.
Hormone replacement therapy and the sensitivity and specificity of breast cancer screening: a review.
Banks E.
Imperial Cancer Research Fund, Cancer Epidemiology Unit, University of Oxford, Gibson Building, Radcliffe Infirmary, Oxford OX2 6HE, UK. bankse@icrf. Icnet.uk
Background:
The use of hormone replacement therapy (HRT) is prevalent in the age group invited to routine breast cancer screening in many countries. Previous publications have reported reduced sensitivity and specificity of mammographic breast cancer screening associated with current use of HRT.
Objectives:
To review the epidemiological evidence for the relation between use of HRT and the risk of having breast cancer diagnosed between screens (interval breast cancer--sensitivity) and being recalled for assessment after initial mammography with no diagnosis of breast cancer at that screen (false positive recall--specificity).
Methods:
Overview of published literature.
Results:
Eight studies were identified, providing a total of 367 interval cancers and 8878 cases of false positive recall, in women of 50 and over. Overall, the studies showed an increased risk of interval cancer and false positive recall in current users of HRT compared with non-users. Only one study accounted for the essential confounding factors of age and menopause. Furthermore, information on duration and recency of HRT use was not available for most studies.
Conclusions:
Studies to date indicate that women using HRT are more likely to experience reduced sensitivity and specificity of breast cancer screening, compared with women not using HRT. However, because results have not been adjusted for crucial confounding factors, the magnitude of these effects is uncertain.
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- 1 What is cancer (malignancy)?
- 2 What is meant by cancer staging?
- 3 How prevalent is cancer?
- 4 How prevalent are womens' cancers?
- 5 What causes cancer?
- 6 Is cancer a hereditary condition?
- 7 How can gynaecological cancer present?
- 8 How can we reduce the risks of the womens' cancers?
Reducing the Risks of Womens' Cancers.
- 9 What are screening tests?
- 10 What are the reactions to a diagnosis of cancer?
- 11 Is there a place for counselling when cancer is diagnosed?
- 12 Can personality alter the prognosis?
- 13 Is the incidence of deaths from the female cancers changing?
- 14 Is there a place for a holistic approach to cancer?
Cancer of the Cervix.
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- 16 What causes cervical cancer?
- 17 How long an interval should there be between cervical screening (smear) (PAP) tests?
- 18 Is there any evidence that cervical screening can reduce the incidence of cervical cancer?
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Endometrial Cancer (Uterus)
- 20 What causes endometrial cancer?
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Cancer of the Ovary.
- 23 How does ovarian cancer present?
- 24 How prevalent is ovarian cancer?
- 25 What are tumour markers?
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- 29 What is the relationship between oral contraception and cancer?
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The Treatment Of Womens' Cancers
- 14 Is there a place for a holistic approach to cancer?
- 32 Can we predict the course of a cancer?
- 33 What treatment options are available for gynaecological cancer?
- Q32.33c What treatment options are available for ovarian cancer?
Cancer of the Vulva, Vagina and Fallopian Tube
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Breast Cancer
- 35 What is the incidence of breast cancer?
- 35 ?What is the cause of breast cancer?
- 35a What are the advantages of breast cancer screening - mammography - mammograms?
- 36 How often should breast screening be carried out?
- 37 Are there any problems having a mammogram?
- 38 Should I check myself for breast lumps?
- 39 One of my family developed cancer of the breast. Am I at increased risk?
- 40 We have a family tendency towards developing breast / ovarian cancer. Are there any genetic tests to find out if I am at increased risk?
- 41 What happens if a mammogram shows an abnormality?
- 42 What are the advantages and disadvantages of tamoxifen in the management of breast cancer?
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Web sites and Support Groups
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